Value Based Care Coordinator

Piedmont Health Services, Inc.; Durham, Northern (NC, KY); On-site; USD 31,000 - 42,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

403(b) Plan

Paid Holidays

CME

Job summary

Piedmont Health Services, Inc. in Durham, NC is seeking a Value Based Care Coordinator to bridge patients, health plans, and our care teams. You will monitor performance metrics, help close care gaps, and support quality improvement initiatives across Population Health.

This role requires a strong understanding of care coordination, data systems, and HIPAA compliance, with daily collaboration across departments.

Qualifications

• High school diploma or equivalent required.
• Bachelor’s degree in social work, healthcare administration, human services, public health or related field preferred.
• 2 years of experience in a healthcare organization required.
• 1–2 years of case management, social work, or relevant work experience preferred.
• Bilingual preferred.
• Maintains a valid driver’s license with auto liability insurance.

Responsibilities

• Obtains and uploads documents into the population health platforms database.
• Assists with care gap assessments and closures.
• Conducts chart reviews to verify care gap data reports.
• Submits supplemental data to health plans to provide documentation of gap closure.
• Meets and collaborates with payor representatives.
• Collaborates with the care team and Population Health Manager in quality improvement projects.
• Ensures urgent issues are shared with care team.
• Conducts care gap outreach and scheduling.
• Participates in all assigned meetings.
• Adheres to privacy and security policies to ensure patient and company data is properly safeguarded. Follows company policies and HIPAA regulations.
• Meets productivity and role expectations, and addresses requests in a timely manner.
• Other duties, as assigned.

Skills

MS Office

Patient data systems

Benefits systems knowledge

Oral and written communication

Organizational skills

Time management

Cultural sensitivity

Medical terminology

Detail oriented

Education

Bachelor’s degree in social work or healthcare

High school diploma or equivalent

Job description

About Piedmont Health Services

Piedmont Health Services, Inc. (PHS) is a 501(c)(3) nonprofit and Federally Qualified Health Center (FQHC) in North Carolina. Dedicated to delivering top-tier, accessible, and inclusive primary healthcare, PHS has proudly served for 55 years and remains the largest community health center in central NC. Operating 11 Community Health Centers, 2 PACE (Program of All-Inclusive Care for the Elderly) SeniorCare facilities, and 2 Mobile Health Units, PHS extends its services to residents across five counties, including Alamance, Caswell, Chatham, Orange, and Lee.

What's an FQHC?

Federally Qualified Health Centers (FQHC) are community-based healthcare providers that receive funds from the Health Resources and Services Administration (HRSA) Health Center Program to provide primary care services in under-served areas.

Job Title -Value Based Care Coordinator

Department -Population Health

Reports to -Population Health Manager

Benefits -

• Medical, Dental, Vision, Life Insurance (Short & Long Term Disability)
• 403(b) Plan
• Paid Holidays
• CME (Continuing Medical Education)

About Position:

• Work Location: 2525 Meridian Parkway - Suite 400, Durham, NC 27713 (PHS Administrative Office)
• Work Schedule: Monday through Friday, 8:00am to 5:00pm

Job Summary:The Value Based Care Coordinator (VBCC) bridges the gap between patients, Piedmont Health Services, and insurance networks to close open care gaps, support transitional care and improve overall health outcomes. This role is dedicated to monitor performance metrics, supplies insurers the supporting documentation requested, ensure chronic conditions are assessed and documented annually as well as conduct patient outreach to close open care gaps. The VBCC will meet regularly with insurance network representatives to discuss measure performance, incentive opportunities and recommended actions. The VBCC will monitor and track payor attribution assignments and assist with quality improvement projects, as well as provide performance data to Population Health Leadership, Quality and Clinical teams at departmental or site meetings. Additionally, the VBCC will conduct chart reviews to verify care gap reports and attempt to close the verified care gaps by conducting patient outreach and scheduling.

Responsibilities/Duties:

• Obtains and uploads documents into the population health platforms database.
• Assists with care gap assessments and closures.
• Conducts chart reviews to verify care gap data reports.
• Submits supplemental data to health plans to provide documentation of gap closure.
• Meets and collaborates with payor representatives
• Collaborates with the care team and Population Health Mananger in quality improvement projects.
• Ensures urgent issues are shared with care team.
• Conducts care gap outreach and scheduling.
• Participates in all assigned meetings.
• Adheres to privacy and security policies to ensure patient and company data is properly safeguarded. Follows company policies and HIPAA regulations.
• Meets productivity and role expectations, and addresses requests in a timely manner.
• Other duties, as assigned.

Minimum Qualifications -

• High school diploma or equivalent, required.
• Bachelor’s degree in social work, healthcare administration, human services, public health or related field, preferred.
• 2 years of experience in a healthcare organization, required.
• 1 – 2 years of case management, social work, or relevant work experience, preferred.
• Bilingual, preferred.
• Maintains a valid driver’s license with auto liability insurance.

Knowledge, Skills, and Abilities:

• Knowledge of and experience working in patient data systems.
• Proficient with MS Office.
• Knowledge of state and federal benefits systems.
• Excellent communication skills – oral and written.
• Excellent organizational and time management skills.
• Sensitivity to diversity of cultures, language barriers, health literacy and educational levels.
• Knowledge of medical terminology.
• Able to respond to changes with a positive attitude and willing to learn new ways to accomplish activities and objectives.
• Able to shift our approach in response to the demands of a situation.
• Detail oriented.

Immunizations:Be medically cleared for communicable diseases and have all immunizations up-to-date prior to beginning employment

Pay Range: $22.49/Hourly - $30.23/Hourly (commensurate with years of experience)

EEO Statement

Piedmont Health Services, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to sex, sex stereotyping, pregnancy (including pregnancy, childbirth, and medical conditions related to pregnancy, childbirth, or breastfeeding), race, color, religion, ancestry or national origin, age, disability status, medical condition, marital status, sexual orientation, gender, gender identity, gender expression, transgender status, protected military or veteran status, citizenship status, genetic information, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.