Kings, CA)

Alignment Healthcare•Tulare, CA

4d•Remote

About The Position

Alignment Health is seeking a proactive, relationship-driven, and highly organized Provider Engagement Specialist to join the Provider Engagement team supporting the Tulare / Kern / Kings, CA market. In this field-remote role, you will build trusted relationships with physician practices and provider groups, partnering with them to improve performance across quality, growth, retention, and utilization metrics while supporting Alignment Health’s continued network expansion. You will spend the majority of your time visiting provider offices throughout the community, presenting performance insights, educating providers on Alignment programs and initiatives, and supporting strategies that help practices succeed while delivering high-quality care to Alignment members. If you're a self-driven professional who enjoys building relationships, solving problems, and helping grow a new market, we're looking for YOU!

Requirements

2 years related experience and/or training; or equivalent combination of education and experience.
Experience in provider relations / contracting with an HMO or IPA, medical group or institutional provider required
B.A./B.S. or equivalent combination of education and experience
Organized, detail oriented, and a self-starter.
Strong analytic, quantitative, and problem-solving skills.
Strong verbal and written communication skills.
Relationship-builder and team-player
Strong presentation skills and ability to address diverse audiences appropriately and effectively.
Proficient user in MS office suite (Word, Excel and PowerPoint).
80% or more travel by car routinely required (In assigned market).
Travel by plane required as needed.
Maintenance of reliable means of transportation and valid driver’s license and automobile insurance required.
Extended works hours, as needed.
Remote work on approval.

Nice To Haves

Bilingual English / Spanish (preferred)

Responsibilities

Build and maintain collaborative relationships with providers and their staff to support growth, retention, and performance improvement.
Partner with providers to improve performance on key performance indicators (KPIs), including but not limited to growth, retention, Annual Wellness Visits (AWVs), HEDIS gap closures, hospital and ER utilization, risk adjustment and other quality indicators.
Conduct initial provider onboarding and provide support for ongoing provider education on Alignment tools, clinical programs, PCP incentives, Member benefit offerings, Model of Care and other compliance requirements, and Alignment initiatives.
Assist in the development of training and educational materials/tools.
Create provider in-service and implementation packets.
Facilitate and serve as a single point of resolution for provider issues, including but not limited to UM, 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.
Consistently utilize, update and maintain department databases and tracking tools to ensure provider engagement activities, provider visits and outcomes are documented and monitored.
Negotiate and implement standard physician and ancillary agreements; obtain provider credentialing; utilize network database to track recruitment activity.
Maintain weekly summary of activity and submit reports on a weekly basis.
Attend and participate in all staff meetings as required.
Perform special projects as assigned.