Provider Relations Advocate

Primary Responsibilities

• Educate providers to ensure they have the tools they need to meet quality, risk adjustment, growth (as appropriate), and total medical cost goals per business development plans
• Ensure providers have an in-depth understanding of WellMed Model of Care to include, but not limited to, contractual obligations, program incentives, and patient care best practices
• Conduct detailed analysis of various reports by tracking and trending data to develop a strategic plan to ensure performance goals are achieved
• Ensure the overall strategic plan incorporates interventions with internal departments or subject matter experts, external vendors, and others, as needed
• Participate in creation and execution of a local network development plan to assure network adequacy as needed
• Conduct new provider orientations and ongoing education to providers and their staff on healthcare delivery products, health plan partnerships, processes, and compensation arrangements
• Maintain open communication with providers to include solutions for resolution and closure on health plan issues related to credentialing, claims, eligibility, disease management, utilization management, quality, and risk adjustment programs
• Conduct provider meetings to share and discuss economic data, troubleshoot for issue resolution, and implement an escalation process for discrepancies
• Collaborate with provider groups to develop, execute, and monitor performance and patient outcomes improvement plans
• Collaborate with Medical Director to monitor utilization trends and profit pools and share results with assigned PCPs
• Handle or ensure appropriate scheduling, agenda, materials, location, meals, and minutes of provider meetings as needed
• Collaborate with contracting team to ensure provider data is correct and provider directories include any needed updates
• Complete Practitioner Data Forms and Provider Change Forms as needed
• Represent WellMed/UHG by holding company sponsored provider events (summits, learning sessions)
• Provide information and participate in management meetings as requested
• Regularly meet with cross functional team to create, revise, and adjust strategy for assigned provider groups to meet overall performance goals
• Provide support to maintain and develop ongoing value related to the WellMed Value Proposition
• Introduce and advocate company resources to facilitate practice optimization

Required Qualifications

• High School Diploma/GED or equivalent experience
• 2+ years of provider relations or managed care experience
• Intermediate level of proficiency with MS Suite (including Word, PowerPoint, and Excel)
• Ability to work evenings and weekends on occasion based on business needs
• Ability to travel as needed 50 - 75%
• Access to reliable transportation and valid US driver's license

Preferred Qualifications

• Bachelor's degree in related field
• LVN license
• Experience presenting group presentations and training
• Professional provider relations experience involving physicians and administrative staff
• Significant understanding of medical care financing and delivery systems, provider contracting, reimbursement arrangements and network management
• Established knowledge of local provider community
• Proven excellent analytical and problem-solving skills with effective follow-through

Physical & Mental Requirements

• Ability to lift up to 25 pounds
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

Pay

The salary for this role ranges from $60,200 to $107,400 annually based on full-time employment.

Benefits

Our mission of helping people live healthier lives extends to our team members. Learn more about our range of benefits designed to help you live well.