Provider Engagement Specialist

This is a fully remote position, open to applicants in California.

📋 Description

• Establish and nurture cooperative relationships with healthcare providers and office personnel.

• Collaborate with providers to enhance growth, retention, Annual Wellness Visits (AWVs), HEDIS gap closures, hospital and ER usage, risk adjustment, and various quality metrics.

• Facilitate provider onboarding and continuous education regarding Alignment Health tools, programs, incentives, member benefits, Model of Care, compliance, and organizational initiatives.

• Create training materials, implementation packets, and educational presentations for providers.

• Act as the main point of contact for provider-related issues, including Utilization Management (UM), prior authorizations, claims, eligibility, encounter data, provider rosters, and directory validation.

• Represent Alignment Health at provider meetings, training sessions, and community events.

• Negotiate and implement agreements with physicians and ancillary services.

• Assist in provider credentialing and recruitment initiatives.

• Maintain documentation of provider engagement, tracking databases, activity reports, and meeting records.

• Participate in staff meetings and undertake special projects as assigned.

⛳️ Requirements

• A Bachelor’s degree (B.A. or B.S.) is preferred, or an equivalent combination of education and experience.

• A minimum of two (2) years of relevant experience and/or training is required.

• Experience in provider relations, provider contracting, network development, healthcare operations, managed care, IPA, HMO, medical groups, or institutional provider settings is essential.

• Proven experience working directly with physician practices and healthcare providers.

• Familiarity with Medicare Advantage, quality programs, risk adjustment, utilization management, and provider performance metrics.

• Strong skills in relationship-building and interpersonal communication.

• Excellent verbal and written communication skills.

• Proficient in presentation and facilitation techniques.

• Strong analytical, quantitative, and problem-solving skills.

• Highly organized, detail-oriented, and self-driven.

• Ability to work both independently and as part of a team.

• Capacity to effectively engage diverse provider audiences.

• Proficient in Microsoft Office Suite (Word, Excel, and PowerPoint).

• Frequent travel by car within the designated market (80% or more) is required.

• Must have reliable transportation, a valid driver's license, and automobile insurance.

• Air travel may be necessary as needed.

• Extended or flexible hours may occasionally be required.

• Bilingual in English and Spanish is preferred.

🏝️ Benefits

• Flexible, self-managed schedule.

• Initial training may involve shadowing an established market team in Raleigh, NC.

• Occasional travel (1-2 times annually) for meetings, training, or conferences.

• Reimbursement for mileage and travel expenses in accordance with company policy.

• Opportunity to make a meaningful impact on seniors and the communities served.

• Opportunities for growth and innovation.

• Reasonable accommodations for individuals with disabilities.

• Commitment to Equal Opportunity/Affirmative Action employment.