Clinical Program Specialist

Position at Healthmap Solutions

Company Background

Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data resources and high-powered analytics to power complex specialty health management programs. Healthmap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.

Position Summary:

The Clinical Program Specialist blends expertise in dynamic project management responsibilities enabling impactful change across clinical teams to improve member/patient outcomes. The role will coordinate clinical and health equity initiatives, oversee aspects of clinical data, update resources, and serve as a central liaison across departments to drive continued success. They additionally will support clinical leadership by reviewing data and interacting with clinical care teams to ensure diagnostic and procedural coding requirements are met when assigned.

Responsibilities:

• Assist with implementing new initiatives as necessary, working in conjunction with the Quality, Clinical, Medical Economics, Product, Clinical Operations and Data Science teams
• Oversee planning, execution, and completion of clinical initiatives, while ensuring alignment with organizational goals
• Manage timelines and resources, identify risks, maintain project documentation to support smooth project delivery, coordinate cross-functional teams, and track project milestones.
• Develop and distribute regular reports to monitor project progress, clinical metrics, and compliance benchmarks
• Act as a liaison between departments, ensuring clear communication and collaboration across clinical, compliance, and operational teams
• Manage content on internal websites and SharePoint sites to enhance accessibility and usability of information for staff
• Partner with the Quality team to ensure assessments and reporting for NCQA, Clients, and other regulatory bodies are met
• Ensure Healthmap’s reporting elements adhere to regulatory and compliance standards in medical coding
• Lead efforts to implement HCC, ICD, CPT, HCPCS and HEDIS coding updates as they are released and serve as the subject matter expert in compliance-related coding issues
• Regularly update and maintain educational resources to reflect current clinical and compliance standards
• Develop or update materials to educate internal users on HEDIS/Stars specifications
• Perform ongoing quality control for Healthmap’s Intervention Engine, Quality Engine, reporting, and other outputs that utilize procedural and diagnostic codes
• Tackle ad-hoc projects, resource allocation, and team needs with precision and flexibility
• Perform other duties as assigned

Requirements:

• Bachelor’s degree in health care or business related required, Masters preferred
• Five (5) years’ experience in healthcare required, preferably in a health plan setting work in medical coding and compliance, project management, or a similar role in a clinical setting
• Certification or equivalent experience in Coding (AAPC or CPC), Medical Risk Adjustment, and HEDIS required. Medicare Stars knowledge preferred

Skills:

• Excellent communication skills and strong organizational skills, attention to detail, and a proactive approach to problem-solving
• Proficient in Microsoft Office and Optum EncoderPro 360
• Solid understanding of project management principles
• Proficiency in Business Intelligence visualization tools preferred
• Demonstrated ability to coordinate cross-functional work teams toward task completion
• Ability to work in a fast-paced work environment, and in the constantly developing technology space
• Excellent presentation skills, interpersonal skills as well as excellent written and verbal communication skills to target audience
• Strong strategic thinking and analytical skills
• Ability to manage multiple priorities

Travel:

• No Travel

LI-Remote

Americans with Disability Specifications

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

As an Equal Opportunity Employer, we will not discriminate against any job candidate or employee due to age, race, religion, ethnicity, national origin, gender, gender identity/expression, sexual orientation, disability, familial status, veteran status, marital status, parental status, or pregnancy. In our innovative and inclusive workplace, we prohibit discrimination and harassment of any kind.