Medical Practice Transformation Specialist

Complete Health•Vestavia Hills, AL

1d•$17 - $20

About The Position

Under the direction of the Practice Transformation leadership, the Practice Transformation Specialist provides comprehensive operational and administrative support for Practice Transformation initiatives, including membership optimization and patient experience strategies in all markets.

Requirements

General knowledge of primary care practices, clinics, hospitals, specialists, ancillary services, medical terminology, and legal/ethical standards of care
Strong communication, collaboration, and conflict-resolution skills; able to work independently and in a team
Decision-making, problem-solving, and organizational skills, including accurate documentation and information analysis
Ability to delegate appropriately, manage emotional or difficult patient interactions, and maintain professionalism and integrity
Sensitivity to cultural diversity, promoting a harassment-free and non-discriminatory environment
Flexibility and adaptability to changing workflows and work environments
High school diploma or a GED is required
Minimum of 2 years medical clinic front office and/or medical assistant experience is required; or equivalent combination of education and experience
Strong computer skills and proficiency in internet software and knowledge of Microsoft Office products is required
Able to effectively utilize an electronic health record
Basic knowledge of Medicare Advantage plans (HMO, PPO, C-SNP, D-SNP)

Nice To Haves

Experience working in Athena EMR, Monday.com and payor portals is desired

Responsibilities

Support payer transitions, attribution clean-up efforts, and roster correction initiatives to ensure accurate VBC alignment and data integrity. This role provides daily operational support to maintain accurate membership records and ensure continuity of care.
Participate in roster data verification and validation to ensure attribution accuracy
Process PCP change forms and assist with payer submissions
Track attribution updates and support internal audits
Validate and update insurance information in Athena
Assist with other practice transformation efforts and related projects
Manage calls to the Patient Relations line about coverage, cost or plan concerns
Facilitate warm hand-offs to licensed brokers if needed
Support VBC retention and conversion initiatives
Support patient enrollment and retention efforts during all Medicare enrollment periods (AEP, OEP, and ROY) by identifying eligible patients
Internally support clinics and staff on plan coverage details
Facilitate broker hand-offs to improve patient experience and continuity of care
Track interactions, outcomes, and enrollment confirmations according to department processes
Ensure accurate payer alignment and attribution with Medicare Advantage plans
Work closely with the Practice Transformation leadership team for direction and prioritization of tasks and projects
Collaborate with internal and external stakeholders including Patient Advocates, Patient Access Center staff and clinic leadership
Participate in meetings, workshops, and training sessions
Maintain professionalism, service excellence, and respectful communication always
Ensure compliance with HIPAA and all company policies and procedures