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 account managers to achieve operational and strategic goals by developing, enhancing, and maintaining operational information and models. Working with local Client Services leadership, the specialist develops and implements business solutions through research and analysis of data and processes. The position builds day-to-day relationships with providers, office staff, and other stakeholders to implement business solutions developed by Optum leadership. It is accountable for the performance and profitability of assigned provider groups and/or financial pools. The role also supports provider groups, health plans, and internal teams through data analysis, process and technology improvements, reporting, strategic planning, and issue resolution.
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 health care 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 and use sound judgment and decision-making.
- Experience conducting performance evaluations to identify 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 within the assigned territory and outside it, as business needs determine, 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 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 affecting revenue, HEDIS/STAR measures, quality metrics, coding, documentation, and education.
- Analyze data to identify business and client trends, patterns, 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 in investigating 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 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, to advance processes and technology improvements.
- 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 concerning product development and performance.
- Collaborate with Client Services leads to foster teamwork and consistency throughout the market.
- Serve as a liaison to the health plan and customers.
- Present information, solve problems, manage conflict, and 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, 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
