Provider Engagement Specialist

Job Number6889Workplace Type:Hybrid RemoteSan Jose,California

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

Overview of the Role:

Provider Engagement Specialist supports the leadership of the Network and Clinical Performance team in the implementation and operation of departmental processes related functions as well as disseminating and gathering of information needed throughout the course of day-to-day operations. Provider Engagement Specialist plays a precise role in strategic growth for the organization by coordinating and executing various strategies in collaboration with internal departments and clinical teams.

Responsibilities:

• Manage and lead practice engagement and performance strategies directly related to MRA/RAF, Star/HEDIS/CAHPS/HOS, provider onboarding, contracting, training on Alignment systems and portals and membership growth.
• Provide outreach and engagement through personal in-office visits, via telephone contact and through email to provider offices, hospitals, ancillary and behavior health providers.
• Outreach and engagement may also include monthly/quarterly JOCs and JWGs meetings, provider and office staff education and partnership collaboration with contracted IPAs.
• Develop and execute physician outreach strategy as needed.
• Working with RVP, establish retention strategies when providers have high disenrollment
• Facilitate and coordinate development plans for physician offices to meet MRA/RAF, Star/HEDIS/CAHPS/HOS measures/goals.
• Educate, facilitate, and be “one touch resolution” or primary contact for resolution to provider inquiries related but not limited to UM, Claims, Eligibility, contracting, directory validation, etc.
• Identify opportunities, obstacles/setbacks. offer suggestions, recommendations to improve or resolve through collaboration with functional area owners.
• Makes recommendation to leadership to enhancing performance improvement.
• Leverage understanding of provider groups including office staff, office culture, systems, capabilities, performance, challenges, and obstacles to success.
• Facilitate strategies in conjunction with leadership strategies improve performance outcomes.
• Coordinate and implementation education and training programs related to organizational and regulatory programs, provide practice support with industry knowledge and consultative problem solving.
• Function as liaison between Provider and organization.
• Identify Provider / Member issues, determine impact, resolve issues, report to Leadership.
• Stay current of the HealthCare industry market standards in the region they are assigned.
• Utilize, protect, and disclose Alignment Healthcare patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and participating in professional societies.
• Coordinate meetings for necessary department leaders and assists in event preparation/scheduling as needed.
• Collect and disseminate reports as needed from/to internal staff within the Network Performance/Network Management Department as well other departments that are under the scope/auspices of the Regional Vice President.
• Other duties as assigned to meet the organization’s needs.

Required Skills and Experience:

• Minimum Experience:
• Minimum 5+ years’ experience in Provider Engagement at a health plan, IPA, Medical Group or similar
• Previous use of EZCAP, EZ Member, Access Express and AVA a plus.
• Proficient user in MS office suite.
• Local travel is required.
• Education/Licensure:
• Bachelor’s degree in Business Administration, Health Care Management or in a related field or equivalent experience preferred.
• Other:
• Strong analytic, quantitative, and problem-solving skills required.
• Strong verbal and written communication skills required.
• Strong presentation skills and ability to appropriately and effectively address diverse audiences required.
• Work Conditions:
• Hours: Monday-Friday, 9am – 5:30 pm. Extended work hours, as needed.
• 50% or more travel by car routinely required.
• Travel by plane required as needed
• Maintain reliable means of transportation. If driving, must have a valid driver’s license and automobile insurance.

Pay Range: $80,000 - $90,000 annually.

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at #/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@.