Medicare Performance Manager

Job DescriptionJob Description

Requirement: Bilingual (Creole and English)

Job Summary:
The Medicare Performance Manager is responsible for overseeing and optimizing the performance of Medicare-related services for our three locations for all of the healthcare plans we service. This role involves daily interaction with staff and collaboration with healthcare providers to ensure compliance with best practices, improve patient outcomes, and enhance service delivery.

Key Responsibilities:

Daily Tasks:
- Review daily hospital census, including Emergency Room (ER) visits and inpatient stays.
- Contact patients to schedule follow-up visits within 7 days of ER and inpatient stays.

Weekly Tasks:
- Analyze Medication Adherence Reports to ensure patients are following prescribed regimens.
- Review all referrals to ensure they are directed to approved providers.
- Reconcile specialist referrals with consultation reports, ensuring proper documentation is scanned into patient charts.

Monthly Tasks:
- Call new patients to welcome them to the center, schedule their initial appointments, and request previous medical records. Ensure patients sign medical record release forms and request records from prior Primary Care Providers (PCPs).
- Conduct monthly meetings with department heads to gather statistics related to:
  - HEDIS (Healthcare Effectiveness Data and Information Set) metrics.
  - Billing and coding performance.
  - Medical Risk Adjustment (MRA) assessments.
- Review monthly claims submitted by health plans/MSOs and make necessary corrections.
- Evaluate RX Cost Saving Reports and implement required medication switches to optimize cost-effectiveness.
- Reconcile ten patient charts monthly and present outcomes to stakeholders during the monthly meeting.

Qualifications:
- Fluency in both Creole and English is required.
- Experience in healthcare management, preferably in Medicare services.
- Strong organizational and communication skills.
- Ability to work collaboratively with multidisciplinary teams.
- Proficient in data analysis and reporting.
- Knowledge of HEDIS metrics and compliance standards.