The 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 Provider Engagement Professional work assignments are often straightforward and of moderate complexity.
The 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. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.
*Incumbent based in San Antonio area, strongly preferred.
Use your skills to make an impact
Required Qualifications
A minimum of two years experience in Healthcare 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
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance
Preferred Qualifications
Bachelor's Degree
Comprehensive knowledge of Medicare policies, processes and procedures
Value based care knowledge
Additional Information