Senior Provider Engagement Specialist
About The Position
The Senior Provider Engagement Specialist is a subject matter expert in Client Service operations, providing consistency, expertise, and operational support to Provider Engagement Specialists in the local market. The role analyzes, reviews, forecasts, trends, and presents information to support operational and business planning. The position partners with assigned provider groups and/or financial pools and fellow account managers to achieve operational and strategic goals. It develops, enhances, and maintains operational information and models, and works with local Client Services leadership to develop and implement business solutions through research and analysis of data and business processes. The specialist builds and maintains day-to-day relationships with stakeholders, providers, and office staff to support implementation of business solutions. The role is accountable for the overall performance and profitability of assigned provider groups and/or financial pools, and serves as a liaison to the health plan and its customers.
Requirements
- At least 5 years of experience in a related medical field or health plan setting, such as network management, contracting, recruitment, provider relations, or medical practice.
- Experience with Medicare healthcare operations, including HEDIS, CMS reimbursement models, and Medicare Advantage.
- Experience developing long-term positive working relationships.
- Experience communicating and facilitating strategic meetings with groups of varied sizes.
- Ability to work independently using sound judgment and decision-making.
- Experience conducting performance evaluations, identifying performance measures or indicators, and determining actions to improve or correct performance against goals.
- Experience resolving complex problems and evaluating options to implement solutions.
- Knowledge of state and federal laws relating to Medicare.
- Proficiency in Microsoft Word, Excel, and PowerPoint.
- Valid driver's license, access to reliable transportation, and ability and willingness to travel locally and non-locally as business needs require, up to 70%.
Nice To Haves
- Healthcare management experience.
- Experience acting as a mentor to others.
- Client management experience.
Responsibilities
- Analyze provider group and/or risk pool performance, including financial statements and other metrics, to identify focus areas and improvement opportunities.
- Develop strategies and action plans that align provider groups and pools with company initiatives, revenue and expense goals, and quality outcomes.
- Drive process and technology improvement initiatives that affect revenue, HEDIS/STAR measures, quality metrics, coding and documentation, and provider education.
- Analyze data to identify trends, patterns, business opportunities, and potential root causes of issues.
- Collaborate with clinical services teams and Client Services leaders to monitor utilization trends and risk pools and develop strategic plans to improve performance.
- Assist provider groups with standard and non-standard requests and problems, including claims and member support services.
- Maintain effective support services by working with Client Services leadership, the Regional Medical Director, Clinical Services, Operations, and other corporate departments.
- Understand providers' business goals and strategies to facilitate analysis and resolution of their issues.
- Compile and report key information through data analysis.
- Use standard project methodology, including requirements, design, and testing, for process and technology improvements.
- Engage providers and provider staff in evaluating functional models and process improvements; identify dependencies and priorities.
- Evaluate and drive processes, provider relationships, and implementation plans.
- Produce, publish, and distribute scheduled and ad hoc client and operational reports related to product development and performance.
- Collaborate with other Client Services leads to foster teamwork and consistency throughout the market.
- Present information, solve problems, manage conflict, and identify resolutions quickly.
- Communicate effectively with physicians, staff, and internal departments.
- Perform other related duties as assigned.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs, subject to eligibility requirements.
- Equity stock purchase, subject to eligibility requirements.
- 401(k) contribution, subject to eligibility requirements.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
