Provider Practice Performance Advisor

Amerihealth Caritas•Baton Rouge, LA

5d•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. The position requires collaboration with providers on HEDIS, withhold measures, Total Cost of Care (TCOC) performance metrics, and other performance-based programs. The advisor will coordinate with the Quality Team on key reports and initiatives related to provider performance and support Account Executives and the local market provider network team in directing interactions related to providers’ quality and performance. The ultimate goal is to improve provider performance.

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.
Must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required.

Nice To Haves

Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Responsibilities

Produce all quality and performance related reporting establishing opportunities and strategies regularly in preparation for JOC’s.
Interpret claims data and connections to patient outcomes and utilization trends.
Interpret utilization trends, optimizing performance based on state driven quality improvement programs i.e. HEDIS.
Attend meetings with providers to review gaps in care and develop plans of action with the provider to address these gaps in conjunction with PNM and CMO as applicable.
Support network and quality strategy.
Implement and provide oversight of performance related projects as corporate best practices and strategy have identified.
Use data and analysis tools to identify opportunities for improved performance and collaborate with peers to develop intervention strategies that can be applied to the provider action plans.
Conduct meetings with providers to review performance data and discuss areas of opportunities to strengthen provider partnerships in conjunction with PNM and CMO as applicable.
Track and prepare reports on action plans and outcomes of initiatives that advance provider VB performance per year.
Provide cross-functional collaboration with PNO, PNM, and Quality program to achieve goals and objectives.
May assist with scheduling appointments for members and attend member outreach meetings in addition to provider meetings.