PROVIDER ENGAGEMENT SPECIALIST

AllCare Management Services•Grants Pass, OR

7d•$27 - $30•Hybrid

About The Position

This position is responsible for promoting Value Based Programs (VBP’s) for contracted AllCare offices. Additionally, this role supports CCO APM participants as they strive for optimal outcomes and promotes the Medicare Advantage Alternative Payment Model with the specific goal of improving the AllCare – Medicare Star ratings. This role educates and promotes the appropriate use of HCC coding among providers who care for our Medicare Advantage members. This position is also responsible for supporting the AllCare provider network in all areas, with a specific focus on the CCO, and Medicare Advantage APM’s, MIPS MPV, PCF and PCPCH. They will be responsible for educating providers and office staff about new AllCare changes, processes, programs, and initiatives.

Requirements

Ability to perform essential job duties with or without reasonable accommodation and without posing a direct threat to safety or health of employee or others.
High school diploma or general education degree (GED).
At least one to three months related experience and/or training in healthcare provider training and education programs, clinic practice management, provider communication, & provider contracts and reimbursement methodologies as they apply in a managed care environment.
Valid Oregon Driver’s License and vehicle insurance.
Familiarity with the Healthcare industry.
Exceptional writing, editing, and proofreading skills.
Excellent organization and time-management skills.
Excellent computer skills, including the Microsoft Office Suite (Outlook, Word, PowerPoint, and Excel).
Knowledge of and compliance with HIPAA regulations.
Knowledge of operating systems, programming languages, software programs, networks and other technologies.
Excellent at identifying and implementing improvement activities and ensuring excellence.
Knowledge of research methodologies and/or data analysis.
Excellent at interpreting data and using it to solve problems and gain new insights.
Knowledge of customer service and service recovery best practices.
Excellent customer service skills to respond appropriately and interact positively with upset customers.
Demonstrate accountability, inspiring trust and confidence from others.
Self-resolve most conflicts or misunderstandings with minimal need for direct supervision.
Work with high initiative, energy and effectiveness in a fast-past environment.
Effectively and professionally communicate with team members and customers.
Collaborate within a multidisciplinary, diverse team to provide professional service.
Interact positively with customers to satisfy needs and resolve problems in a pleasant and professional manner.
Prioritize and organize work according to competing timelines.
Allocate your time so that you can complete tasks within established deadlines.
Adapt to change, learn quickly, and work with ambiguity.
Use creativity and resourcefulness to solve new problems.
Cope and self-manage during stressful situations.
Maintain an attentive and empathetic demeanor.
Maintain a high degree of professionalism and confidentiality.
Effectively work with people with mental illness and from diverse backgrounds and experiences.
Provide respectful and understanding service to customers within a multicultural environment.
Create a pleasant experience for all customers, such as being personable and attentive.
Meet timelines for goals safely and with high level of quality.
Negotiate, consider many viewpoints and settle differences quickly.
Make decisions independently in accordance with established policies and procedures.
Take initiative and apply sound judgment in completing tasks and responsibilities.
Seek out information to learn more about our environment and community.
Examine and shift behaviors, as appropriate.
Commit to being culturally aware.
Ability to read and comprehend simple instructions, short correspondence, and memos.
Ability to write simple correspondence.
Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Job requires specialized computer skills. Must be adept at using various applications including database, spreadsheet, report writing, project management, graphics, word processing, presentation creation/editing, communicate by e-mail and use scheduling software.
Ability to solve practical problems and work with a variety of concrete variables in situations where only limited standardization exists.
Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
The employee must occasionally lift and/or move up to 10 pounds.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
The employee is occasionally required to stand; walk and reach with hands and arms.
The employee must be able to work onsite as needed.
The employee must be able to work from a home office as needed.
The employee must be able to travel locally as needed.
The employee has exposure to communicable disease and body fluids.
Because of exposure to patient records of all types, the highest standard of patient confidentiality and privacy as established by business policy and HIPAA requirements must be maintained.

Nice To Haves

May require the use of personal vehicle for local travel (subject to mileage reimbursement).
May require the use of a personal cell phone (cell phone stipend applicable).

Responsibilities

Represents AllCare Health in a professional manner.
Act as the Subject Matter Expert (SME) for one of the following areas: Social Determinants of Health (SDOH), CCO APM, HCC Coding, Medicare Advantage APM, or PCPCH.
Responsible for promoting the CCO Alternative Payment Models and the Medicare Advantage Alternative Payment Model.
Educate and support practices who participate in the CCO and Medicare Advantage APM’s as well as those clinics who participate in Federal or State incentive programs such as: MIPS MVP, PCF and PCPCH.
Disseminates quarterly reports and gap lists to providers participating in the CCO and Medicare Advantage APM’s.
Assists in the development of training materials for the CCO and Medicare Advantage APM’s.
Assists in the planning and coordination of meetings. Including, but not limited to Collaboratives, APM Planning and Quarterly Provider Network Meetings.
Represent AllCare Health in a professional and collaborative manner in all provider-facing activities.
Support clinics in achieving quality benchmarks and shared savings in AllCare Value Based Payment Programs.
Deliver tailored training and technical assistance to providers and office staff through in-person, virtual, and written communication.
Disseminate and clarify updates on AllCare processes, program changes, and VBP initiatives.
Plan and facilitate provider meetings including collaboratives, educational sessions, and quarterly network meetings.
Serve as liaison between provider offices and AllCare departments, communicating needs, resolving concerns, and sharing insights.
Support implementation and tracking of federal and state incentive programs.
Support MSO clinics in achieving quality benchmarks and shared savings.
Assist with the development of annual plans and outcomes goals for MSO practices.
Conduct chart reviews and identify areas for clinical and operational improvement.
Use payer portals and data platforms to support accurate tracking and care gap closure.
Maintain working knowledge of clinic EHR systems to support providers in data entry and workflow optimization.
Participate in outcome-focused meetings with MSO and VBP teams to analyze data and identify actionable opportunities.
Complete daily, weekly, and monthly responsibilities, checklists, and documentation.
Participate in regular internal meetings (e.g., weekly Teams check-ins with the team).
Assist with chart audits, including OHA Hybrid Measures as needed.
Provide back-up coverage for departmental staff when required.
Maintains punctual, regular and predictable attendance.
Works collaboratively in a team environment with a spirit of cooperation.
Respectfully takes direction from leadership.
Meets all required training including those listed in Relias Learning Module System (LMS).
Performs other duties as assigned.