Provider Engagement Specialist

Description:

Evaluates provider performance and develops strategic plan to improve performance. Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization. Seeking individuals with previous Project Management/Lead experience.

• Serve as primary contact for providers and act as a liaison between the providers and the health plan
• Triages provider issues as needed for resolution to internal partners
• Receive and effectively respond to external provider related issues
• Investigate, resolve and communicate provider claim issues and changes
• Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
• Perform provider orientations and ongoing provider education, including writing and updating orientation materials
• Manages Network performance for assigned territory through a consultative/account management approach
• Evaluates provider performance and develops strategic plan to improve performance
• Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
• Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)
• Develop proficiency in tools and value based performance (VBP) and educate providers on use of tools and interpretation of data
• Coaches new and less experienced External Reps
• Completes special projects as assigned

Ability to travel locally 4 days a week

Skills:

• Provider relations,
• Provider claims/reimbursement,
• Managed Care Contracting
• Medicare
• Medicaid

Additional Skills & Qualifications:

• Bachelors degree in related field or equivalent experience.
• Three years of provider relations, provider claims/reimbursement, or contracting experience. Knowledge of health care, managed care, Medicare or Medicaid.
• Bachelors degree in healthcare or a related field preferred.
• Claims billing/coding knowledge preferred.
• Perform provider orientations and ongoing provider education, including writing and updating orientation materials

Experience Level:

Expert Level

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.