About Bmc wellsense
WellSense Health Plan to become the largest Medicaid health plan in the state, covering more than 500,000 MassHealth members in eight ACO partnerships across MassachusettsBOSTON – WellSense Health Plan, part of Boston Medical Center Health System, has been selected by the Baker-Polito Administration to expand its participation in the Accountable Care Organization program, doubling the number of its MassHealth ACO partnerships from four to eight, while improving care and coordination for members in its network.After enrollment begins in April, WellSense Health Plan will cover more than 500,000 lives in Massachusetts, supporting the care of nearly 40% of MassHealth ACO adult and child members across the state.The selection by the Baker-Polito Administration makes WellSense the largest partner in the state in caring for a Medicaid ACO population, as well as the largest Medicaid plan overall.The Baker-Polito Administration selected a total of 17 health care organizations across the state, including eight partnerships with WellSense Health Plan, for the re-procurement, which goes into effect April 1, 2023. MassHealth ACOs are integrated networks of physicians, hospitals and other community-based health care providers that are accountable for the quality, cost and member experience of care for 1.2 million MassHealth members.Photo credit: Frank Conte, EastBoston.com“This is a transformational milestone for WellSense and our entire health system,” said Alastair Bell, MD, the Chief Operating Officer of BMC Health System. “This significantly expands our mission, and places WellSense, BMC Health System and our eight partner ACOs at the heart of payment and delivery of high-quality care to low-income populations in Massachusetts.”With state approval, WellSense has renewed ACO agreements with four partners that were initially approved for five-year contracts beginning in March 2018:Boston Accountable Care Organization, which includes Boston Medical Center, its physician network and many of its affiliated health centers; Signature Healthcare Corporation in Brockton; SouthCoast Health in New Bedford, Fall River and Wareham; and Mercy Hospital (Sisters of Providence Health System) in Springfield.The four new ACO partnerships include:Beth Israel Lahey Health Performance Network Boston Children’s Health ACO East Boston Neighborhood Health Center Tufts Medicine and Lowell Community Health Center with WellSense “Working with MassHealth and our eight ACO partners, we will improve health outcomes by continuing to provide access to high-quality care and helping adults and children live their healthiest lives,” said Heather Thiltgen, President of WellSense Health Plan. “Together, we will tackle the most difficult challenges for our members and continually push for innovation in the Medicaid program.”“Serving the Medicaid population is central to our commitment to health equity and improving the health of the people and communities we serve,” said Beth Roberts, president of Beth Israel Lahey Health Performance Network. “We are pleased to partner with WellSense, given their deep experience with Medicaid population health management and our shared commitment for collaborating on behalf of and advocating for our patients.”“Partnering with WellSense Health Plan to introduce this ACO brings tremendous value to our patients and supports our mission of providing high-quality, integrated care to those we serve,” said Greg Wilmot, President and CEO of East
Key features of the Bmc wellsense that are enabled through these drivers include:
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- WellSense/BMC for ACO and SCO Plans - Mass.gov
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- WellSense Signature (HMO) - 2025 BMC Health System, Inc
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It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.* Please note: THIS IS A CODE EVERYTHING ROLE - You must have strong proficiency using a coding book, this is not an HCC coding role. Hours are 7:00 AM – 3:30 PM EST OR 8:00 AM – 4:30 PM ESTAn assessment is part of the interview process using an ICD-10 coding bookJob Summary:The Coder manages the day-to-day responsibilities of chart abstraction, vendor auditing and reporting in accordance with state and federal regulations. The coder will abstract from in-patient and out-patient medical records and record findings via electronic database and or excel spread sheets. The coder ensures that all claims accurately reflect the appropriate diagnosis information as outlined in the member’s medial record. Our Investment in You:· Full-time remote work· Competitive salaries· Excellent benefitsResponsibilities · Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation. · Ability to code government and state models. This includes code everything projects. · Maintain current knowledge of ICD-10-CM codes, CMS documentation requirements, and state and federal regulations. · Ability to maintain a 95% accuracy rate on all coding projects. · Coders assist with code abstraction and coding quality audits using the Official Coding Guidelines for ICD-9-CM/ICD-10-CM, AHA Coding Clinic Guidance, and in accordance with all state regulations, federal regulations, internal policies, and procedures. Requirements · Current core coding credentials through AHIMA or AAPC (RHIT, CCS, CCS-P, CPC, CIC, etc.) The AAPC CRC (Certified Risk Adjustment Coder) coding certification is highly recommended. · Strong organizational skills · Technical savvy with high level of competence in basic computer skills, Microsoft Outlook, Word, Excel and Outlook. · Strong written and verbal communication skills · Ability to work independently in a remote environment · Private lockable office space to ensure security of Member PHI · Minimum of 5 years coding experience with at least 3 of those years in Risk Adjustment coding. · Completion of an accredited medical coding program with current unencumbered credentials. Required education: · CPC Certification Required experience: · Risk Adjustment coding: 3 years · Coding: 5 years Supervision Received · General supervision is received weekly About WellSenseWellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees
