DescriptionThe Senior Provider Engagement Professional develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Senior Provider Engagement Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.
The Senior Provider Engagement Professional represents the scope of health plan/provider relationship across such areas as financial performance, incentive programs, quality and clinical management, population health, data sharing, connectivity, documentation and coding, HEDIS and STARs performance, operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence. Begins to influence department’s strategy. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.
- Bachelor's Degree or relevant 3+ years of experience
- 5+ years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
- Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
- Demonstrated ability to manage multiple projects and meet deadlines
- Proficient in Microsoft Office
- Masters Degree
- Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
- Comprehensive knowledge of Medicare policies, processes and procedures
Additional Information : Ideal Candidate should live within 30 miles of the the Tri-City Tennessee area or Southwest Virginia area.
This position requires 50-75% travel to provider offices within the territory.
Scheduled Weekly Hours40