Practice Management Consultant

Responsibilities

• Evaluate and monitor providers’ performance standards and financial performance of contracts as requested to support THP goals.
• Make regular visits, in-person, by phone and/or video call, to providers and act as primary resource for driving quality, operational efficiency and membership growth and retention.
• Travel throughout THP managed care service area, as required or assigned.
• Outreach to contracted provider offices to educate as necessary.
• Identify workflow processes and training to develop target initiatives to improve quality reporting.
• Facilitate contracted provider meetings.
• Aid in the education of providers on all THP applications.
• Work directly with clinical data and analytics team to track service trends and educate providers.
• Implement and coordinate programs to build and nurture relationships between THP, providers and office managers.
• Collaborate with Quality Improvement team to complete quality and department initiatives.

Requirements

• Held accountable for servicing providers within their territory and outside of territory, as assigned.
• Perform on-site reviews of new and re-credentialed providers within their assigned territory.
• Identify and educate providers requiring additional education (performed on-site, via conference call and/or via webinar).

Qualifications

• Required College degree or 3-4 years’ experience in a physician’s office, payer agency, community agency or other health care environment.
• Valid driver’s license.
• Previous customer service experience with exposure to claims and benefits interpretation and provider networking.
• Knowledge of medical coding.
• Knowledge of HEDIS® and Star Ratings.
• Computer experience with Microsoft Word, Excel, Power Point and Outlook.

Skills

• Strong verbal and written communication skills with the ability to communicate (oral and written) effectively.
• Strong project management skills.
• Must be able to perform presentations for small and large audiences in person and remotely.
• Organizational skills with the ability to handle multiple tasks and/or projects at one time.
• Customer service skills with the ability to interact professionally and effectively with providers, and staff.
• Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time.
• Problem resolution skills.
• Ability to work under little supervision and act as a team member.
• Familiar with current managed care, State and/or Federal healthcare programs (Medicare, Medicaid) and the insurance industry.
• Experience in managed care, State and/or Federal health programs.
• Certified Medical Insurance Specialist (CMIS) and Certified Medical Coder (CMC).
• Value based reimbursement/initiatives/projects experience.

Pay

TBD

Schedule

8:00am - 5:00pm