Practice Performance Advisor

Amerihealth Caritas•Columbus, OH

8d•Hybrid

About The Position

The Performance Practice Advisor is part of the POD support model and provides support to the Provider Network Management team and Provider Network. This role is responsible for producing and presenting performance reports, Value-Based Care (VBC) models, care coordination effectiveness, and practice efficiencies. AmeriHealth Caritas is a mission-driven organization with over 30 years of experience, dedicated to delivering comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Requirements

Associate's Degree Required
Bachelor’s degree in healthcare administration or similar field required.
Five (5) or more years of experience in provider networking if no bachelor's degree.
3 or more years Account Executive experience, total cost of care, understanding of reimbursement methodologies to include risk or Value Based contracting.
Understand quality and provider performance reporting and HEDIS or other quality measures.
Healthcare regulations, reimbursement models and quality measures.
Possesses strong analytical skills to interpret and prepare provider performance data.
For roles that are 100% remote or hybrid, must have access to a reliable high-speed internet connection (minimum bandwidth of 50 Mbps download and 5 Mbps upload).

Nice To Haves

Knowledge for Value-based contracts with providers as it relates to HEDIS, withhold measures, TCOC performance metrics and other quality-based programs.
General Operational Knowledge related to provider satisfaction, education and communication with a fundamental understanding of operational items such as claims coding, payment integrity, provider data, credentialing, appeals disputes etc. applicable to State, Federal and STARS standards to ensure compliance.

Responsibilities

Collaborates with providers regarding HEDIS, withhold measures, TCOC performance metrics, and other performance-based programs.
Coordinates with the Quality Team on key reports and initiatives related to provider performance.
Supports Account Executives and local market provider network teams in directing interactions related to providers’ quality and performance.
Responsible and accountable for improving provider performance.
Produces all quality and performance-related reporting, establishing opportunities and strategies regularly in preparation for Joint Operating Committee (JOC) meetings.
Interprets claims data and connections to patient outcomes and utilization trends.
Interprets utilization trends, optimizing performance based on state-driven quality improvement programs (e.g., HEDIS).
Attends meetings with providers to review gaps in care and develops plans of action with the provider to address these gaps in conjunction with Provider Network Management (PNM) and Chief Medical Officer (CMO) as applicable.
Supports network and quality strategy.
Implements and provides oversight of performance-related projects as identified by corporate best practices and strategy.
Uses data and analysis tools to identify opportunities for improved performance and collaborates with peers to develop intervention strategies applicable to provider action plans.
Conducts meetings with providers to review performance data and discuss areas of opportunity to strengthen provider partnerships in conjunction with PNM and CMO as applicable.
Tracks and prepares reports on action plans and outcomes of initiatives that advance provider VB performance per year.
Provides cross-functional collaboration with Provider Network Operations (PNO), PNM, and Quality programs to achieve goals and objectives.
May assist with scheduling appointments for members and attend member outreach meetings in addition to provider meetings.