Senior Provider Engagement Specialist

Overview

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

The Senior Provider Engagement Specialist has geographic responsibility for the quality and economic performance of the physician practice with the goal of developing a high performing provider network within the State of Kansas and Missouri. This includes analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning. The Senior Provider Engagement Specialist will develop and sustain a solid day-to-day relationship with stakeholders, the physician and office staff to effectively implement the business solutions developed by the Client Services leadership team.

They are accountable for overall performance and profitability for their assigned groups as well as ownership and oversight to provide redirection as appropriate and approved. The responsibilities of this position include capabilities in the following areas: strategic planning and analysis; understanding of HEDIS, Star ratings, accurate documentation and coding; highly developed communication skills; and the ability to develop clear action plans and drive process.

If you are located in Southeast Wisconsin, you will have the flexibility to work remotely
* as you take on some tough challenges.

• Educate providers to ensure they have the tools needed to meet quality, coding and documentation, and total medical cost goals per business development plans
• Develops strategies and create action plans that align provider pools and groups with company initiatives, goals, quality outcomes, program incentives, and patient care best practices
• Drive processes and improvement initiatives that directly impact revenue, HEDIS/STAR measures and quality metrics, coding and documentation process and educational improvements
• Conduct new provider orientations and ongoing education to provider and their staff on healthcare delivery products, health plan partnerships, processes, and tools
• Use and analyze data to identify trends, patterns and opportunities for the business and clients, and collaborate and/or participate in discussions with colleagues and business partners to identify potential root cause of issues
• Conduct provider meetings to share and discuss reporting data and analysis, issue resolution needs, implement escalation processes for discrepancies, and handle or ensure appropriate scheduling, agenda, and materials
• Collaborates with internal clinical services teams, alongside operational leaders, to monitor utilization trends to assist with developing strategic plans to improve performance
• Assists provider groups with investigating standard and non-standard requests and problems, to include claims and member support services
• Maintains effective support services by working effectively with the medical director, operations, and cross functional teams, and other departments
• Demonstrate understanding of providers' business goals and strategies in order to facilitate the analysis and resolution of their issues
• Performs all other related duties as assigned

• Solid analytical skills required to support, compile and report key information
• Drive processes that directly impact Revenue, HEDIS/STAR measures and Quality Metrics, and total cost of care, as appropriate
• Use data to identify trends, patterns and opportunities for the business and clients. Develop business strategies in line with company strategic initiatives
• Engage provider staff and providers in analysis and evaluation of 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 relating to the performance of related metrics and goals
• Collaborate with internal leaders to foster teamwork and build consistency throughout the market
• Serves as a liaison to the health plan and all customers
• Requires…