Program Coordinator, Government Programs - 25-98

We're delighted you're considering joining us!

At Hill Physicians Medical Group, we're shaping the healthcare of the future: actively managed care that prevents disease, supports those with chronic conditions and anticipates the needs of our members.

Join Our Team!

Hill Physicians has much to offer prospective employees. We're regularly recognized as one of the "Best Places to Work in the Bay Area" and have been recognized as one of the "Healthiest Places to Work in the Bay Area." When you join our team, you're making a great choice for your professional career and your personal satisfaction.

DE&I Statement:

At PriMed, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are.

We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities. We do it because it's right!

Job Description:

The Program Coordinator will support key operational functions across Government Programs, with a focus on Medicare Advantage and ACA risk adjustment, Medi-Cal quality incentive programs, data validation, encounter error reconciliation, and vendor performance oversight. Core responsibilities include data analysis, cross-functional coordination and project management. Based on department needs, coordinators may be assigned one or more of the following focus areas:

Primary Focus Areas (assigned individually or in combination):

• Annual Wellness Visit (AWV) Operations: Coordinate vendor activities and monitor performance related to AWV outreach and completion. Ensure accurate visit tracking across Cozeva and Epic. Collaborate with stakeholders to improve engagement and chronic condition capture. Reconcile invoices to claim submissions and ensure alignment with contracts and Scope of Work agreements. Ideal candidate: Detail-oriented, organized, and experienced in AWV workflows, vendor management, and outreach optimization.
• Health Plan Incentive Program Oversight: Support development and reporting for provider and health plan-sponsored incentive programs. Track performance, validate eligibility, and ensure contract alignment. Provide insights and recommendations to improve program participation and outcomes. Ideal candidate: Experienced with provider-facing or payor-aligned programs and incentive metrics, with strong data acumen.
• Data Extraction & Analytics: Analyze performance data to identify trends, gaps, and root causes, particularly in HCC chronic condition capture. Work closely with platforms like Cozeva and Epic. Manage submissions of ASM, MMR, MOR, MAO-004, and CMS delete files, and maintain robust performance dashboards. Ideal candidate: Highly analytical and able to turn data into actionable insights that improve program performance.
• Encounter Error Reconciliation: Oversee reconciliation of encounter errors submitted to health plans. Requires knowledge of claims processing, adjustments, and encounter submission workflows. Analyze error data to identify systemic issues and drive process improvement. Ideal candidate: Skilled in data analysis and experienced in resolving health plan data discrepancies to ensure accurate reporting for risk adjustment and quality performance.
• Medi-Cal Program Oversight: Support Medi-Cal program operations in compliance with Department of Healthcare Services (DHCS) regulations, contract terms, and state guidance. Monitor regulatory updates, interpret policy changes, and ensure operational alignment. Ideal candidate: Familiar with APLs, PLs, and Medi-Cal encounter and eligibility standards, and able to partner across teams to maintain compliance.

Job Responsibilities:

• Analyze large datasets to identify performance trends and root causes of RAF or chronic condition capture variances
• Monitoring CMS submissions and identify trends or errors (e.g., MAO-004)
• Prepare accurate target lists for outreach
• Collaborate with health plans, vendors, informatics, and regional teams
• Communicate insights and trends to senior leadership and cross-functional teams
• Manage recuring and ad hoc data tasks with accuracy and timeliness
• Oversee supplemental data processes and file management (ASM, MAO-004)

Required Education, Experience & Skills:

• Bachelor's degree preferred; equivalent experience with strong Excel and communication skills considered
• Minimum 2 years in healthcare data or government programs operations (Medicare Advantage, ACA, Medi-Cal preferred)
• Advanced Excel skills required (pivot tables, V-lookup, formulas, charts/graphs)
• Familiarity with Tableau, Cozeva (or other patient registry tools), MMR, MOR, MAO-004, and CMS delete files
• Working knowledge of HCC coding and ICD-10 in the context of risk adjustment
• Strong project coordination, data analysis, and communication skills
• Valid driver's license: occasional travel may be required (Bay Area, Sacramento, San Joaquin PriMed offices)

Additional Information:

Salary: $68,000 - $86,000 Annual

Hill Physicians is an Equal Opportunity Employer