Provider Performance Advisor (South Texas Market)

About the role

The Provider Performance Advisor (PPA) is primarily a market-based position that also supports emerging markets outside of their physical location. The PPA serves as a trusted advisor, consultant, and partner to provider practices, working directly with physicians, practice leadership, and clinical teams to improve operational performance, quality outcomes, and Equality Health Value-Based Care (EH VBC) success. As the face of Equality Health within assigned markets, the PPA builds strong relationships, influences provider and staff behavior, and represents the organization with professionalism, credibility, and a consultative approach.

Responsibilities

• Enable and enhance practice performance in the EH VBC Network
• Responsible for supporting assigned practice teams in implementing adoption of the EH VBC program in the following key areas:
  • Improve Access to Care
  • Improve preventive Wellness Visit rates
  • Improve Chronic Condition Management
  • Reduce avoidable IP & ER admissions and readmissions
  • Improve appropriate coding, documentation, and timely billing
• Align practice group on network quality performance goals
• Evaluate practice behavior change and quality performance against goals
• Measure and monitor practice population health management and present performance results to both EH and practice executive leadership
• Identify practice barriers and support practice with recommendations to surmount barriers to performance
• Change management driver: Partner with provider practices to drive sustainable operational and behavioral change that improves quality performance, patient outcomes, and VBC success
• Monitor, document, and report practice progress; recommend next action based on determination of progress: escalate for network optimization action
• Enhance utilization of CareEmpower or other population health management tool to support practice population health management
• Facilitate implementation of Equality Health’s digital data retrieval and integration
• Support and training of all practices in the markets assigned, with feedback loops to the Practice Account Manager (PAM)
• Represent EH as the face of the organization within assigned markets, cultivating provider engagement, strengthening partnerships, and driving successful adoption of VBC strategies

Requirements

• Bachelor's degree in business, public health or a related field of study; or an equivalent of education and/or experience in healthcare delivery systems
• Must possess a valid driver's license, maintain reliable personal transportation, and be willing and able to travel extensively (up to approximately 75%) throughout assigned local and regional markets to support provider practices
• Minimum of 3 years of experience in the healthcare industry, preferably in the provider practice setting: primary care/ specialty care practice management, medical assistance, quality (HEDIS/STARs), revenue cycle
• Minimum of 3 years of experience in the health care industry, preferably as a practice manager, coder, medical assistant, quality (HEDIS/STARs) analyst, or a revenue cycle analyst
• Minimum of 1 year of experience in Medicaid and Medicare value-based care and population health management
• Experience with HEDIS, STARs (Quality measures), and medical coding and billing (revenue cycle)
• Electronic Health /Medical Records (EHR/EMR) experience
• Demonstrated ability and experience to drive change: practice transformation, practice performance improvement
• Demonstrated ability to engage providers and support staff and drive performance to achieve a mutual patient population and care management goals

Preferred Skills, Abilities & Qualifications

• Practice Management experience
• Any Quality certifications (example: CPHQ – Certified Professional in Healthcare Quality or other)
• Medical Assistant credentials or experience
• EMR template-building ability and experience