Provider Relations Rep - ACO

UHS•Amarillo, TX

4h•Remote

About The Position

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience. Learn more at: https://prominence-health.com/ Job Summary: ACO Provider Relations Representative is responsible for assisting in the full range of provider relations and service interactions for all lines of business within Prominence Health Plan. Will assist in the design and implementation of programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Supports those who direct and implement strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs, and may also be involved in identifying and remediating operational short-falls and researching and remediating claims; and is responsible for steerage initiatives, site visits, training, educating, and overall communications including portals, webpages, letters, and email messages. Responsible for the oversight and management of Medicare Quality Reporting during each performance year and through the annual reporting periods and ensures resources are in place to complete the annual GPRO reporting requirement. This position is remote and work from home with travel around Amarillo and Lubbock, TX.

Requirements

BS, Bus Admin, Finance or similar field, or equivalent work history
2+ years in HEDIS, ACO, or Care Gap reporting
2+ years working with Medicare contracts and regulatory reporting requirements
3 years in managed care or medical insurance.
2 years working in a clinical setting.
1 year in a claims, customer service or provider support role.
Excellent oral and written English communication skills including telephone etiquette.
Superior interpersonal skills
Proficient research, critical-thinking and analytical problem-solving skills
Intermediate proficiency with Microsoft Office (Excel, Word, PowerPoint, Outlook).
Self-starter and resourceful with ability to execute projects in a fluid and fast paced environment
Strong organizational, planning and attention to detail skills.
Valid Driver’s License, reliable transportation, and proof of insurance required
Requires local travel and occasional out of area overnight travel required.

Responsibilities

Assisting in the full range of provider relations and service interactions for all lines of business within Prominence Health Plan.
Assist in the design and implementation of programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers.
Supports those who direct and implement strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs, and may also be involved in identifying and remediating operational short-falls and researching and remediating claims
Responsible for steerage initiatives, site visits, training, educating, and overall communications including portals, webpages, letters, and email messages.
Responsible for the oversight and management of Medicare Quality Reporting during each performance year and through the annual reporting periods and ensures resources are in place to complete the annual GPRO reporting requirement.