Wellsense health plan bmc

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

Boston Neighborhood Health Center. “As part of our longstanding commitment to advancing health equity, I am excited by this opportunity for East Boston Neighborhood Health Center to provideeven greater care and improve clinical outcomes for our patients.”About WellSense Health PlanWellSense Health Plan is a nonprofit health insurance company serving more than 440,000 members across Massachusetts and New Hampshire through Medicare, Individualand Family, and Medicaid plans. Founded 25 years ago, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.About East Boston Neighborhood Health CenterFrom@EBNHC twitter feedEast Boston Neighborhood Health Center (EBNHC) is one of the nation’s largest Federally Qualified Health Centers (FQHCs) and the largest community health center in Massachusetts, serving over 100,000 patients, and recognized by the Health Resources and Services Administration (HRSA) as a Health Center Quality Leader. For more than 50 years, EBNHC has offered access to comprehensive care for the underserved populations of Chelsea, Revere, East Boston, Winthrop, Everett and Boston’s South End. East Boston Neighborhood Health Center is dedicated to promoting and sustaining healthy communities, families, and individuals by providing accessible, person-centered, compassionate, and high-quality health care services to all who live and work in our service area, regardless of ability to pay, while upholding diversity, equity, and inclusion at the core of all we do. www.ebnhc.orgSource: Greenough Agency 11/16/2022

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

Resources BMC offers many great employee benefits and tools and resources to help you maximize those benefits. Need to find information quickly? This page was designed to help you easily locate commonly used BMC benefits, features and information. Save Money, Get Great Care Can you imagine driving a car off the dealer’s lot and getting a bill in the mail later? That’s how it used to be with health care. Now, shopping for high-quality and reasonably priced health care is quick and simple. These great tools and resources are included with your BMC medical coverage to help you shop smart for health care services and make informed decisions about your care. Teladoc Medical Experts Start a virtual visit with an MDLIVE® doctor or psychologist (Use BCBS member ID, which starts with BMY) BCBSTX health advocate: Get help planning diagnostic tests and surgeries BCBSTX Blue365 Discount Program: Save money on health care products and services The MDLIVE Mobile App* connects you with a doctor from anywhere, anytime. In addition to medical and pediatric care, MDLIVE also offers behavioral health therapy services and psychiatry. *Available if enrolled in a BCBSTX medical plan. bWell at BMC The BMC wellness program — bWell — gives you the opportunity to assess your current health status and provides you with tools and a support system to improve or maintain your health. Participating in bWell can help you save on health care costs too. Each year you have the opportunity to earn medical plan premium credits that reduce your next year’s monthly paycheck costs for health care. bWell Program Overview Preparing for Retirement If you’re considering retirement from BMC, you’ve got a lot on your mind. These resources can help you make critical decisions as you plan for the next phase of life. Journey to Retirement BCBSTX Resources When you enroll in a Blue Cross Blue Shield of Texas medical plan, you enjoy access to an array of resources to help you manage your health and make informed health care decisions. Telehealth through MDLIVE: Get convenient care at your fingertips. Overview Blue Access Mobile: Check your coverage, find a doctor from your mobile phone and more. Overview Get the app 24/7 Nurseline: Get answers to health problem questions anytime Overview

In accordance with the Terms of Use and delivered to the customer Project Manager. Pre-requisites:For non-SaaS migrations, the BMC Helix platform must already be implementedFirewall ports must be open between monitoring environment and BHOMSome integrations may require additional licensingMinimum BMC PATROL agent version is 21.02 or higherAdditional information:In-scope Product: BMC Helix MonitorService Type: DeploymentAvailability: ActiveSuccess Service Code:BHOM_MIGR_002_OFFSHOREBHOM_MIGR_002_ONSHOREBHOM_OBIN_002_OFFSHOREBHOM_OBIN_002_ONSHOREBHOM_RULE_002_OFFSHOREBHOM_RULE_002_ONSHOREBHOM_IBIN_002_OFFSHOREBHOM_IBIN_002_ONSHOREBHOM_DASH_002_OFFSHOREBHOM_DASH_002_ONSHOREDate Last Updated: 5/14/2024Related Resources:Additional BMC Services:As part of your ongoing adoption and extension of BMC capabilities and solutions, the following services complement this one:AIOps Advisory ServiceThis Service will assess an organization’s current state and provide a future state roadmap to implement AIOps.BMC Helix Dashboards and Reporting Starter ServiceThis Service will leverage and configure best-in-class dashboards to support BMC customers and their business needs.BMC Helix Discovery Starter ServiceThis Service will configure CMDB and BMC Helix Discovery to discover datacenter endpoints, providing visibility across multi-cloud environments.BMC Helix Monitoring Starter ServiceThis Service configures a base operating system monitoring solution, providing visibility into infrastructure and business services.BMC Helix Event Management Starter ServiceThis Service enables event management activities related to event enrichment, blackout, suppression, correlation, and notification.Accelerator: AIOps Anomaly DetectionThis Service configures policies that leverage AIOps functionality to monitor the health of systems and applications.BMC Helix Intelligent Integration Starter ServiceThis Service configures OOTB integration to retrieve event, metric, and topology data to improve observability into your infrastructure and business services. Getting started is easy

Success Catalog BMC Helix Operations Management Migration Service 126+ CREDITS This Service migrates Customer’s TrueSight Operations Management (TSOM) or BMC Proactive Performance Management (BPPM) implementation to BMC Helix Operations Management (BHOM). This includes monitoring configurations, event management rules and policies using the migration tool, integrations, dashboards, reports, and users. What you get:BMC will perform the following based on the selected levers: (See table below)BMC will perform the following in a non-production environment with a copy to a production environment, if needed:As seen in the table below, BMC will perform one or more of the following:The Items and Quantity(ies) (QTY) listed below will be migrated for the Customer as standard practice within this service.If the Customer would like BMC to perform incremental migration activities that fall outside of the Quantities listed below, Additional Quantities can be acquired to match the Customers current TSOM environment being migrated.Alternatively, the Customer can have BMC perform the migration items within the limits listed below and complete the rest independently.BMC will provide this Service with one of the delivery types listed below:ItemsQTYOutbound Integrations1Event Management Rules/PoliciesInbound Event IntegrationsTSOM Dashboards and ReportsUp to 10Standard Delivery Credits Required126Country-Specific Staffing195Estimated Duration16+ weeksAdditional Quantity Options:ItemsAdditional QTYStandard Delivery CreditsCountry-Specific Staffing CreditsOutbound Integrations138Event Management Rules/PoliciesUp to 50919Inbound Event Integrations5612TSOM Dashboards and Reports538Analyze and DesignConduct a workshop to analyze the existing TSOM or BPPM implementationPrepare Migration Design Document with a migration plan and an assessment of BMC PATROL agents and Knowledge Modules (KMs)* that need to be upgradedPrepare for MigrationInstall and configure event management cellsAssist Customer with installation and configuration of forward proxy servers if required for PATROL metricsMigrate groups, users, and permissions from Remedy Single Sign On (SSO) to BMC Helix SSOProvide scripts and procedures for Customer to migrate BMC PATROL agents into BHOM (Customer Responsibility)MigrateMigrate TSOM or BPPM Central Monitoring Administration (CMA)