Practice Performance Advisor

Amerihealth Caritas•Newark, DE

1d•Remote

About The Position

The Practice Performance Advisor is part of the POD support model and supports the Provider Network Management team and Provider Network in producing and presenting performance reports, value-based care (VBC) models, care coordination effectiveness measures, and practice efficiencies. This position supports network and quality strategy, works with providers to review performance and gaps in care, and helps develop action plans and interventions to improve provider performance. This position is fully remote. The Associate must be located in Delaware to attend in-office meetings as needed.

Requirements

Bachelor’s degree in healthcare administration or a similar field, or five or more years of experience if no bachelor’s degree.
Three or more years of Account Executive experience, total cost of care experience, and understanding of reimbursement methodologies, including risk or value-based contracting.
Understanding of quality and provider performance reporting and HEDIS or other quality measures.
Knowledge of healthcare regulations, reimbursement models, and quality measures.
Strong analytical skills to interpret and prepare provider performance data.

Responsibilities

Produce quality- and performance-related reports and regularly identify opportunities and strategies in preparation for JOCs.
Interpret claims data and its relationship to patient outcomes and utilization trends.
Interpret utilization trends and optimize performance based on state-driven quality improvement programs, such as HEDIS.
Attend provider meetings to review gaps in care and develop plans of action with providers, in conjunction with PNM and CMO as applicable.
Support network and quality strategy.
Implement and oversee performance-related projects identified through corporate best practices and strategy.
Use data and analysis tools to identify opportunities for improved performance and collaborate with peers to develop intervention strategies for provider action plans.
Conduct provider meetings to review performance data and discuss opportunities to strengthen provider partnerships, in conjunction with PNM and CMO as applicable.
Track and prepare reports on action plans and initiative outcomes that advance provider value-based performance per year.
Collaborate cross-functionally with PNO, PNM, and the Quality program to achieve goals and objectives.
May assist with scheduling member appointments and attend member outreach meetings in addition to provider meetings.
Support value-based provider contracts related to HEDIS, withhold measures, total cost of care performance metrics, and other quality-based programs.
Apply general operational knowledge related to provider satisfaction, education, and communication, including claims coding, payment integrity, provider data, credentialing, appeals, and disputes, as applicable to State, Federal, and STARS standards to ensure compliance.