Provider Relations Representative

Position SummaryThe Provider Relations Representative (PRR) serves as a point person for practices, helping them to succeed in providing high quality, patient-centered care. This position works collaboratively with Community Care of North Carolina (CCNC) statewide teams, Community Care Physician Network (CCPN) and assigned practices that serve our member populations to provide the necessary education, tools, and resources to ensure success in value-based care. Essential Functions

Serves as point person for practices through the following functions:

• Proactively develops and maintains strong Provider Relations to increase participation and engagement with CCPN through regular meetings and other forms of outreach.
• Provides education to practice staff, along with tools and resources to meet the needs of the population through best practice guidelines, practice management support, and/or other appropriate resources, to promote quality and cost-effective outcomes.
• Actively conducts recruitment outreach to enroll eligible practices in CCPN and CCNC contracts and programs in collaboration with the Contracts and Programs team.
• Supports growth of the network through active recruitment of new practices to join CCPN.
• Utilizes data comprehension skills to identify individual provider needs and aggregate trends and prioritizes work with practices through critical data analysis to improve quality and close care gaps.
• Ensures practices log in to the CCNC VIP data platform regularly (monthly at a minimum) and utilize the Recommended Actions tab, Write-back functionality, ADT report, resources in the Private Portal, etc.
• Discuss data with the practice on a regular basis to provide analysis and interpretation and support the practice with continuous quality improvement using the QI Plan and other internal tools.
• Engages other SMEs as needed and team members to support the QI work as needed (e.g., Dyad team, QI Specialists, Contract/Program Specialists, EMR Specialists, Billing and Coding Specialists, etc.).
• Delivers provider and practice education, including training on platforms (e.g., Practice Perfect Suite), new practice orientations, refreshers, in- services on regional and CCNC/CCPN programs and initiatives, and other information as needed.
• Promotes and attends monthly practice manager and provider meetings, as appropriate, to ensure understanding of information for dissemination to PCPs.
• Networks with providers and other important contacts for statewide operations, CCNC, and CCPN.
• Maintains updated practice information in Insightly database to include, but not limited to, number of physicians, operation hours, practice contacts, quality engagement level etc.
• Documents practice outreach and interactions in a timely manner according to documentation guidelines.
• Fosters relationships and maintains communication with multiple disciplines, including CCNC Care Management, Pharmacy, Account Management, Behavior Health, OB, Clinical Performance, Network Relations, PHP representatives, DHHS/DHB, etc.
• Maintains member and family confidentiality in accordance with HIPAA.
• Represents the organization in a professional manner.
• Travel using personal vehicle may be required, at times.
• Other job duties as required.

Qualifications

• Bachelor’s Degree in a health care field is highly preferred; Associate’s degree with two years of equivalent work experience; OR a minimum of five years of equivalent work experience
• Experience in data analysis & interpretation highly preferred
• Experience in working within a medical practice is highly preferred
• Experience in quality reporting/EHR technical assistance is highly preferred
• Experience in marketing and communication techniques such as Motivational Interviewing (MI) and Academic Detailing
• Maintain a valid driver’s license with current auto liability insurance

Knowledge, Skills, and Abilities

• Embrace our corporate culture, including our vision, mission, and values
• Effective communicator who utilizes academic detailing (AD) skills; is able to present oral and written information clearly, concisely and within a timely manner
• Displays Emotional Intelligence (EI) skills through an ability to respond versus react, accept, and utilize feedback, and maintain positive, respectful work relationships through self-management and strategic relationship building
• Forward thinking and solution-oriented; able to turn challenges into opportunities and take action to improve business processes
• Able to manage multiple tasks/projects, including prioritizing duties, meeting deadlines, and providing on-time responses to management, supervisor, and co-worker requests
• Demonstrates a commitment to accuracy and thoroughness
• Punctual, reliable, able to begin work as scheduled and attend mandatory meetings
• Basic knowledge of Medicaid, healthcare payment, and governance
• Analytical skills, sound judgment and self-direction are necessary, as independent decision making and problem solving is often necessary
• Computer skills, including fluency in Microsoft Office applications (Word, Excel, PowerPoint, etc.)
• Familiarity with data analysis and interpretation; ability to appropriately communicate results verbally and in writing based on target audience as determined by specific functions of the role
• Utilization of QI methodologies such as the Model for Improvement with rapid cycle PDSAs and other evidence-based strategies and techniques
• Comfort with public speaking in front of people across multiple disciplines

Working Conditions

• Routinely there may be some minor physical inconveniences or discomforts in the work setting, including sitting for moderate periods of time
• Must be able to utilize office equipment, computer, keyboard, and phone with or without assistive devices
• Repetitive wrist motion and occasional lifting/carrying of up to 25 pounds
• Minimal travel within the region and/or state
• The job environment is primarily work at home via virtual meetings, with occasional needs to visit a medical practice in person. Exposure to general office conditions, as well as communicable diseases could occur.
• Evening and weekend work may be required with advance notice and corresponding adjustment in work week schedule