Provider Engagement Specialist

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

📋 Description

• Establish and nurture collaborative relationships with providers, office personnel, and key stakeholders to enhance network growth and efficiency.

• Facilitate provider onboarding, orientations, and continuous education programs.

• Conduct regular in-person visits to providers to assess performance metrics and pinpoint areas for improvement.

• Analyze provider performance data and provide actionable insights to enhance outcomes.

• Educate providers on HEDIS, Stars, Risk Adjustment, and documentation/coding requirements.

• Design and implement strategies for provider engagement aimed at boosting quality scores and enhancing member experience.

• Assist in resolving provider-related issues concerning access, claims, eligibility, and utilization management.

• Create and present training materials, in-service presentations, and Model of Care training sessions.

• Ensure accurate maintenance of provider data and activity records in Salesforce and internal systems.

• Aid in provider recruitment, contracting, and credentialing processes.

• Negotiate and execute provider agreements in designated markets.

• Monitor recruitment and contracting activities and deliver regular reports.

• Act as a primary contact for provider inquiries, ensuring prompt resolution.

• Engage in team meetings and contribute to special projects as necessary.

• Utilize independent judgment and decision-making skills on complex issues with minimal oversight.

⛳️ Requirements

• At least 1 year of experience in provider relations, contracting, or network management within an HMO, IPA, medical group, or healthcare organization.

• Over 2 years of experience in provider-facing roles, particularly in Medicare lines of business (preferred).

• Solid understanding of HEDIS, Stars, Risk Adjustment, and MLR.

• High School Diploma or GED (Bachelor’s degree or equivalent experience preferred).

• MBA (preferred).

• Proficiency in Microsoft Office (Word, Excel, PowerPoint).

🏝️ Benefits

• Health insurance.

• 401(k) matching.

• Flexible work arrangements.

• Paid time off.

• Professional development opportunities.