ArchWell Health

Lead and develop member experience strategies, oversee implementation and evaluation, and serve as a liaison to improve healthcare member satisfaction. | Minimum 5 years managing member experience initiatives in healthcare, with strong analytical, communication, and regulatory knowledge. | Member Experience Advisor Job Summary ArchWell Health Member Experience Advisor, reporting to the Member Experience Director, will be an integral part of the central services team. The Member Experience Advisor will provide direction and oversight in the development and maintenance of a comprehensive Member Experience program. The Member Experience Advisor will work with colleagues, providers and leadership to study, select, implement, analyze, report on and evaluate targeted strategies to improve member experience. The Member Experience Advisor will work collaboratively with leaders and others and serves as a change agent to improve the member experience in a measurable way and will serve as a resource on industry strategies in member experience excellence. The Member Experience Advisor will work with the survey vendor to review evidence-based strategies and national trends. This role also supports the design, execution, and analysis of health plan surveys to assess member satisfaction and identify opportunities for improvement, contributing to strategic initiatives that enhance overall member experience and drive performance in regulatory quality ratings. Essential Duties/Responsibilities Facilitate the development of evidence-based, innovative and creative strategies for improving member experience in a measurable way. Observe provider and center colleague interactions and deliver constructive, tactful feedback to support individual performance improvement. Oversee activities related to member experience, including monitoring multiple teams as they implement and evaluate strategies. Provide reports, information, and follow up to various teams to ensure that activities are implemented effectively and achieving expected outcomes. Serve as a liaison between ArchWell Health and the survey vendor to gain knowledge, gather information, develop reports and troubleshoot. Identify trends in patient experience scores and work collaboratively with management to develop action plans. Lead assigned projects and programs by creating and executing workplans. Present member experience information at team, provider and leadership meetings as requested. Required Education and Experience: Bachelors degree or a minimum of 5 years of direct experience managing member experience initiatives within a healthcare delivery system or health plan Knowledge of how healthcare is delivered and how member experience is measured by regulatory agencies Advanced proficiency in Microsoft Excel, including the ability to create dashboards, charts, and visualizations that clearly communicate member experience performance to end users Experience interpreting and applying CMS and other regulatory guidance related to member experience measurement Strong analytical and communication skills, with the ability to translate complex data into actionable insights Knowledge, Skills, and Abilities: Strategic thinker with a passion for improving the healthcare experience. Excellent interpersonal and facilitation skills. Ability to manage multiple project plans and priorities on an ongoing basis. Ability to share data and provide coaching to center colleagues and providers in a concise and effective way. Embodies and serves as a role model of ArchWell Health’s Values: Be compassionate Strive for excellence Earn trust Show respect Stay resilient Always do the right thing Travel and Location Remote Travel can be up to < 70%; role requires travel to various centers.

Assist members with healthcare navigation, verify provider data, and document interactions. | High school diploma, healthcare experience, proficiency in Microsoft Office, understanding of Medicare Advantage. | ArchWell Health is a new, innovative healthcare provider devoted to improving the lives of our senior members. We deliver best-in-class care at comfortable, accessible neighborhood clinics where seniors can feel at home and become part of a vibrant, wellness-focused community. Our members experience greater continuity of care, as well as the comfort of knowing they will be treated with respect by people who genuinely care about them, their families, and their communities. Job Summary: The Member Services Representative is responsible for providing outreach to our members to help them navigate the complex healthcare delivery system. This will entail verifying their primary care physician and eligibility and contacting their insurance plan when applicable to ensure they are assigned to ArchWell Health. This role has the potential to handle provider data management and will need to verify AWH provider information with these insurance partners when applicable. An ideal candidate will have a deep understanding of the healthcare ecosystem, have strong attention to detail, and be driven by a passion for providing quality care to seniors. Duties/Responsibilities: • Outreach to members and insurance partners over the phone to verify members are assigned to ArchWell Health and schedule members for appointments • Complete proper documentation of all member and payor outreach • Assist members in problem solving potential issues related to the health care system • Validate provider data on file with insurance partners • Utilize and manipulate shared Excel spreadsheets to track membership and interactions. Required Skills/Abilities: • Proficient PC skills to include Microsoft Office and Excel • Passion for helping senior members successfully carry out care plans • Ability to work effectively with diverse populations including staff, providers, members, family members, insurance carriers, vendors, and the public • Basic medical terminology • Understanding of Medicare Advantage Education and Experience: • High school diploma or equivalent education (GED) required • A minimum of one year working in healthcare, ideally with experience related to benefits and insurance required • eClinical Works or similar EMR experience preferred ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.

Oversee clinical risk management programs including incident reporting, investigations, regulatory compliance, risk assessments, and policy implementation to ensure safety and compliance in healthcare operations. | Bachelor’s degree in nursing, juris doctorate, or related field; 5+ years healthcare risk management experience; preferred Master’s degree and risk management certification; strong healthcare regulations knowledge and analytical skills. | Program Manager, Risk ArchWell Health is a new, innovative healthcare provider devoted to improving the lives of our senior members. We deliver best-in-class care at comfortable, accessible neighborhood clinics where seniors can feel at home and become part of a vibrant, wellness-focused community. Our members experience greater continuity of care, as well as the comfort of knowing they will be treated with respect by people who genuinely care about them, their families, and their communities. The Program Manager, Risk will play a critical role in ensuring the safety, compliance, and risk management of our health care operations. Reporting directly to the Director of Risk Management, this person will be responsible for overseeing the incident reporting process, managing the grievance process, and leading the approval and implementation of new policies to enhance our risk management strategies, Duties/Responsibilities: Coordinates the Clinical Risk Management Program to meet the needs of the organization Manages the incident reporting process and reviews and analyzes all occurrences for risk management, quality of care, regulatory and insurance concerns Conducts root cause analysis investigations, focused investigations, and other reviews and investigations. Manage professional and general liability carrier reporting and follow-up. Assist providers with managing licensing board letters of inquiry and investigations. Create quarterly reports reviewing incidents for trends and process improvement. Collaborate with relevant departments to analyze incident data, identify trends, and develop strategies to prevent recurrence. Work closely with compliance regarding regulatory matters. Conduct regular risk assessments across various aspects of the organization, including clinical practices. Collaborate with departments to identify potential risks and develop mitigation plans. Stay up to date with industry regulations and standards related to healthcare risk management. Provide training and educational programs to colleagues on risk management, incident reporting and grievance resolution. Promote a culture of safety and risk awareness throughout the organization. Maintain detailed records of incidents, health plan grievances, and risk assessment. Create update and maintain risk management policies and procedures that outline the organization’s approach to managing risks. Ensure the organization complies with relevant laws, regulations and industry standards related to risk management and safety. Performs other related duties Required Skills/Abilities: Strong knowledge of healthcare regulations and accreditation standards Excellent communication, problem solving and interpersonal skills. Ability to collaborate with cross functional teams. Diligence and a commitment to promoting a culture of safety. Ability to assess potential risks to prioritize them based on their impact and likelihood. Strong analytical skills to collect and interpret data, perform risk analysis, and make data driven decisions. Proficiency in developing and implementing risk mitigation strategies. Ability to identify problems, analyze their root causes and develop creative solutions to mitigate or eliminate risk. Proficiency in crisis management and the ability to respond effectively to unexpected events or emergencies that pose a risk to the organization. Education and Experience: Bachelor’s degree in nursing, juris doctorate, or related field Master’s Degree preferred Certification in risk management preferred. Minimum of 5 years of experience in healthcare risk management or a related field ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.

Conduct audits and reviews to ensure compliance with healthcare laws and company policies, communicate findings, maintain compliance reporting, and manage audit schedules. | 5+ years in healthcare compliance auditing or related roles, knowledge of Medicare/Medicaid coding rules, healthcare compliance certifications preferred, strong communication and analytical skills. | Audit Analyst, Compliance, Privacy & Risk Management Job Summary: The Audit Analyst for Compliance, Privacy & Risk Management is responsible for the oversight and management of auditing and monitoring high-risk, problem prone processes, completing compliance risk assessments to ensure compliance with federal/state laws and regulations, and ArchWell Health policies. Duties/Responsibilities: • Adheres to assigned audit schedule and reviews as outlined in the Compliance Workplan • Assists with reviewing internal and external inquiries regarding compliance and privacy matters, including government and third-party payor requests. • Conducts audits and focused reviews to ensure compliance with company, government, and payor guidelines. • Responsible for effectively communicating information and audit findings through presentations, graphs, reports, and educational materials, etc. • Assists with maintaining regular and consistent governance-level reporting and metrics for the Compliance department, including but not limited to dashboards, board reporting, weekly, monthly, and annual compliance & ethics reporting. • Maintain a working knowledge of HIPAA, HHS, and CMS regulations. • Participate in the planning and scheduling of compliance projects. • Research compliance related questions upon request from departments and/or practices. • Identify and report potential audit and compliance risks. Required Skills/Abilities: • Knowledge of Medicare and Medicaid documentation and coding rules and guidelines. • Must have an understanding and knowledge of national and state laws and regulations • Must have excellent verbal and written communication skills. • Strong interpersonal skills • Strong organizational and planning skills. • Demonstrates a high degree of personal integrity and practice ethical standards. • Demonstrates proactiveness and ability to work independently and self-directed in managing multiple concurrent projects. • Excellent analytical and problem-solving skills. • Advanced skills in all MS Office applications (Word, Excel, Outlook, and PowerPoint). • Ability to interpret and apply documentation and coding rules and regulations. • Ability to demonstrate competence in performing audits, produce reports, formulate remediation or mitigation plans, and conduct follow-up audits. Minimum Qualifications: • Equivalent of 5+ years’ experience in compliance auditing, clinical chart reviews, medical necessity review/auditing, revenue integrity, and/or health care compliance • Experience in compliance and privacy auditing techniques and methods • Certified in Healthcare Compliance (CHC) or Certified in Healthcare Privacy Compliance (CHPC) preferred • Bachelor's degree in related field preferred • Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC) preferred At ArchWell Health, we’re creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life. Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We’re passionate about caring for older adults and united by the belief that caring has the power to change everything for our members. ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.