Senior Provider Engagement Specialist
About The Position
The Senior Provider Engagement Specialist serves as 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. It partners with provider groups and/or financial pools and fellow account managers to meet operational and strategic goals by developing, enhancing, and maintaining operational information and models. In partnership with local Client Services leadership, the specialist develops and implements business solutions through research and analysis of data and business processes. The specialist builds and maintains day-to-day relationships with key stakeholders, providers, and office staff to implement business solutions developed by Optum leadership. The position is accountable for the overall performance and profitability of assigned provider groups and/or financial pools. It also supports business and client planning through data analysis, reporting, process improvement, provider engagement, and collaboration with internal teams. The role requires communicating effectively with physicians, staff, health plans, and internal departments, and includes local and non-local travel based on business need.
Requirements
- At least 5 years of experience in a related medical field or health plan setting, such as network management, contracting and/or 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 all sizes.
- Ability to work independently using sound judgment and decision-making.
- Experience conducting performance evaluations to identify performance measures or indicators and actions needed to improve or correct performance relative to 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.
- Reliable transportation and ability and willingness to travel locally in the assigned territory and non-locally, as determined by business need, up to 70%.
Nice To Haves
- Healthcare management experience.
- Experience acting as a mentor to others.
- Client Management experience.
Responsibilities
- Analyze risk pool and provider group performance, including financial statements and other metrics, to identify areas for focus or improvement.
- Develop strategies and action plans that align provider pools and groups 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, documentation, and education.
- Analyze data to identify trends, patterns, opportunities, and potential root causes of issues; collaborate with colleagues and business partners on findings.
- Partner with internal clinical services teams and Client Services leaders to monitor utilization trends and risk pools and develop strategic performance plans.
- Assist provider groups with standard and non-standard requests and problems, including claims and member support services.
- Maintain effective support services through collaboration with the Director of Client Services, Regional Medical Director, Clinical Services, Operations, and corporate departments.
- Understand providers’ business goals and strategies to facilitate analysis and resolution of their issues.
- Compile and report key information through data analysis.
- Apply standard project methodology, including requirements, design, and testing, to process and technology improvement initiatives.
- Develop business strategies aligned with company strategic initiatives.
- Engage provider staff and providers in evaluating functional models and process improvements, and 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 relating to product development and performance.
- Collaborate with other Client Services leads to foster teamwork and consistency throughout the market.
- Serve as a liaison to the health plan and all customers.
- Use presentation, problem-solving, and conflict-management skills to identify resolutions quickly.
- Communicate with physicians, staff, and internal departments.
- Perform other related duties as assigned.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase.
- 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
