Provider Engagement Specialist

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

📋 Description

• Assist in achieving the performance and growth goals for the designated market by fostering relationships with primary care physicians and specialist providers.

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

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

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

• Educate providers regarding HEDIS, Stars, Risk Adjustment, and necessary documentation/coding standards.

• Design and execute strategies for provider engagement aimed at boosting quality scores and enhancing member experiences.

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

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

• Ensure accurate maintenance of provider data and activity tracking using Salesforce and internal systems.

• Assist with provider recruitment, contracting, and credentialing activities.

• Negotiate and implement provider agreements within the assigned markets.

• Monitor recruitment and contracting efforts, providing regular reports on progress.

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

⛳️ Requirements

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

• 2+ years of experience in a provider-facing role, with a preference for Medicare lines of business.

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

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

• A valid driver’s license is mandatory.

• Reliable transportation and current automobile insurance are required.

🏝️ Benefits

• Health insurance

• 401(k) matching

• Flexible work hours

• Paid time off

• Remote work available with approval