Provider Engagement Specialist – Medicare Advantage | Wake County, NC
About The Position
Alignment Health is seeking a Provider Engagement Specialist to develop and maintain strong relationships with provider offices, improve network performance and provider satisfaction, and support organizational growth. The role partners with providers on patient retention and growth strategies and on performance across quality and utilization metrics. The specialist is the primary point of contact for providers, providing education, support, and tools to help them achieve their goals. The position includes onboarding and educating providers, supporting provider agreements and credentialing, resolving provider issues, and representing Alignment Health at meetings and community events. It also requires documenting engagement activity and outcomes, maintaining databases and reports, and routinely traveling by car within the assigned market. Travel by plane may be needed. Extended work hours may be required, and remote work is available with approval.
Requirements
- Two years of related experience and/or training, or an equivalent combination of education and experience.
- Experience in provider relations or contracting with an HMO, IPA, medical group, or institutional provider.
- A bachelor's degree or two years of relevant experience.
- Organized, detail-driven, and self-starting.
- Strong analytical, quantitative, and problem-solving skills.
- Strong verbal and written communication skills.
- Relationship-building and teamwork skills.
- Strong presentation skills and the ability to address diverse audiences effectively.
- Proficiency with Microsoft Word, Excel, and PowerPoint.
- Reliable transportation, a valid driver's license, and automobile insurance.
- Ability to routinely travel by car at least 80% of the time within the assigned market and travel by plane as needed.
Nice To Haves
- Bilingual.
Responsibilities
- Build and maintain collaborative relationships with providers and their staff to support growth, retention, and performance improvement.
- Partner with providers to improve key performance indicators, including growth, retention, Annual Wellness Visits, HEDIS gap closures, hospital and ER utilization, risk adjustment, and other quality indicators.
- Conduct initial provider onboarding and provide ongoing education on Alignment tools, clinical programs, PCP incentives, member benefits, the Model of Care, compliance requirements, and Alignment initiatives.
- Assist in developing training and educational materials and create provider in-service and implementation packets.
- Serve as a single point of resolution for provider issues involving utilization management, prior authorization, claims, encounter data, eligibility, provider rosters, and directory validation.
- Represent Alignment Health at provider meetings, trainings, and community events; document meeting minutes and action items as needed.
- Maintain department databases and tracking tools to document and monitor provider engagement activities, visits, and outcomes.
- Negotiate and implement standard physician and ancillary agreements, obtain provider credentialing, and use the network database to track recruitment activity.
- Maintain and submit weekly activity summaries and reports.
- Attend and participate in staff meetings as required.
- Perform special projects as assigned.
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What This Job Offers
Job Type
Full-time
