Provider Engagement Administrator II
November 9
Description
• 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 • Performs other duties as assigned • Complies with all policies and standards
Requirements
• Bachelor’s 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 • Claims billing/coding knowledge preferred
Benefits
• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules
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