Senior Provider Performance Specialist

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

📋 Description

• Assist in the development of provider performance strategies related to risk adjustment, quality metrics, medical loss ratio, incentive programs, and value-based care.

• Examine provider and population-level data to pinpoint gaps, trends, and areas for enhancement.

• Facilitate provider-specific action plans through data segmentation and targeted strategies for closing gaps.

• Execute focused strategies aimed at improving clinical quality outcomes, patient satisfaction, and financial results.

• Educate and advise providers on quality performance expectations, program requirements, documentation standards, coding accuracy, and opportunities for evidence-based care.

• Address complex issues related to performance and metrics.

• Align and refine incentive programs to optimize provider engagement and performance levels.

• Integrate quality-based incentives with value-based reimbursement structures.

• Leverage standardized tools, dashboards, and job aids to enhance provider engagement and the effectiveness of internal teams.

• Assist in the reporting and tracking of quality performance.

• Ensure uniform implementation of performance initiatives across provider groups.

• Stress the importance of consistent quality improvement and the adoption of best practices.

• Collaborate with internal stakeholders on quality improvement programs, regulatory requirements, and value-based initiatives.

• Travel as necessary to support provider performance initiatives.

⛳️ Requirements

• A Bachelor’s Degree in a Health-Related or Business-Related field or equivalent work experience is mandatory.

• A minimum of 4 years of progressive experience in healthcare, quality improvement, or provider performance is required.

• Proven experience with risk adjustment, quality programs (such as HEDIS, STARS, etc.), value-based care models, and incentive programs or MLR drivers.

• Advanced skills in healthcare data analysis and the development of performance insights.

• Proficiency in risk adjustment, HEDIS/STAR quality programs, and value-based care models.

• Strong capabilities in provider consulting and performance enhancement.

• Understanding of healthcare financial drivers including MLR and incentive structures.

• Ability to convert analytics into actionable strategies for providers.

• Sponsorship is not available for this position.

🏝️ Benefits

• Approximately 25% travel is mandated, primarily for occasional on-site provider visits.

• Travel as needed to support provider performance initiatives (around 60% of the time).