Provider Practice Performance Advisor

Amerihealth Caritas•Newark, DE

1d•Remote

About The Position

The Provider Practice Performance Advisor is part of the POD support model and supports the Provider Network Management team and Provider Network. The role produces and presents performance reports, supports value-based care models, evaluates care coordination effectiveness, and identifies practice efficiencies. This is a fully remote position. The Advisor uses claims and performance data to identify opportunities, develop improvement strategies, and support provider action plans. The role works with providers and internal teams on quality improvement, HEDIS, value-based performance, and other quality-based programs, while supporting network and quality strategy and applicable operational and regulatory requirements.

Requirements

Bachelor’s degree in healthcare administration or a similar field, or at least 5 years of experience if the candidate does not have a bachelor’s degree.
At least 3 years of Account Executive experience.
Experience with total cost of care 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 reports, identify opportunities and strategies, and prepare regularly 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, including HEDIS.
Meet with providers to review care gaps and develop action plans to address them in conjunction with PNM and the 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 performance improvement opportunities and collaborate with peers on 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 the CMO, as applicable.
Track and prepare reports on action plans and initiative outcomes that advance provider value-based performance each 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 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 and compliance.