Bachelor's Degree required or comparable work experience will be considered.
Minimum 5 years of experience in professional services, including practice management, nursing, clinical documentation improvement or quality audit.
In-depth knowledge of medical terminology, anatomy and physiology, pharmacology, and pathology required.
Extensive knowledge of coding and documentation requirements including ICD-10-CM, CPT-4, and HCPCS.
Excellent verbal and written communication skills, analytical skills, and organization skills required.
Extensive problem-solving experience is required.
Experience working with physicians and physician practices.
Goal-oriented and experience with development and implementation of action plans.
Excellent customer service required.
Ability to interact with public in a diplomatic and tactful manner and represent the Health Plan effectively.
Ability to manage relationships with assigned practices and maintain records of all activities.
Ability to develop action plans as required.
Proficient computer skills.
Self-motivated with the ability to work with minimal supervision.