This dynamic role supports the performance and growth objectives of the market/pod by engaging with network primary care and specialist providers. Supports network growth through outreach and contracting with prospective providers. This role also involves supporting day-to-day network operations.
The Provider Engagement Specialist is in the market and the face of Alignment Health Plan in their assigned market or geography.
General Duties/Responsibilities (May include but are not limited to):
Develop collaborative relationships with key providers, provider office staff, and other downstream entities to promote growth and improve performance benchmarks.
Conduct initial provider orientations and provide support for ongoing provider educational outreach (direct networks).
Conduct outbound follow up to providers in order to resolve access to care issues.
Assist in the development of training and educational materials/tools. Create Provider in-service packets and implementation packets. Coordinate, conduct, and/or initiate Model of Care Trainings for external providers.
Consistently and accurately utilize department databases and tracking mechanisms to ensure all key departmental processes are met. Update and maintain accurate information in Sales Force. Create distribution lists for various email notifications and campaigns.
Understanding of Managed Care operations, Risk Adjustment, and HEDIS measures
Educate, Facilitate, and be "one touch resolution" or primary contact for resolution to provider inquiries related but not limited to UM, Claims, Eligibility, contracting, directory validation, etc.
Negotiate and implement standard agreements with physicians and ancillary providers in existing and developing markets.
Obtain provider credentialing information and prepare supporting contract documentation for contract implementation.
Utilize network database to track both provider recruitment activity and executed contracts.
Maintains weekly summary of activity and submits report on a weekly basis.
Attends and participates in all staff meetings as required.
Performs special projects as assigned to help drive leads for the company.
Supervisory Responsibilities:
N/A
Minimum Requirements:
Minimum Experience:
Two years related experience and/or training; or equivalent combination of education and experience.
Experience in provider relations / contracting with an HMO or IPA, medical group or institutional provider required
Education/Licensure:
B.A./B.S. OR 2 years relevant experience
Other:
Bi-lingual preferred.
Organized, detail driven and a self-starter.
Strong analytic, quantitative, and problem-solving skills.
Strong verbal and written communication skills.
Relationship-builder and team-player
Strong presentation skills and ability to address diverse audiences appropriately and effectively.
Computer Skills: Proficient user in MS office suite (Word, Excel and PowerPoint).
80% or more travel by car routinely required (In assigned market).
Travel by plane required as needed.
Maintenance of reliable means of transportation and valid driver's license and automobile insurance required.
Extended works hours, as needed.
Remote work on approval.
Work Environment:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
The employee is frequently required to reach with hands and arms.
The employee is occasionally required to stand; walk; climb or balance and stoop, kneel, crouch, or crawl.
The employee must occasionally lift and/or move up to 25 pounds.
Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.
