Provider Relations Rep - ACO (Amarillo, TX)

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

Responsibilities

• Assist in the full range of provider relations and service interactions for all lines of business within Prominence Health Plan.
• Support the design and implementation of programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers.
• Support those who direct and implement strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist network contracting and development staff in prioritizing contracting needs.
• Identify and remediate operational shortfalls, research and remediate claims.
• Lead steerage initiatives, site visits, training, educating, and overall communications including portals, webpages, letters, and email messages.
• Oversee and manage Medicare Quality Reporting during each performance year and through the annual reporting periods.
• Ensure resources are in place to complete the annual GPRO reporting requirement.

This position is hybrid with significant travel in Amarillo, TX. Must travel around Amarillo and Lubbock, TX (75% travel).

Requirements

• Bachelor’s degree in Business Administration, Finance, or similar field, or equivalent work history.
• 2+ years in HEDIS, ACO, or Care Gap reporting.
• 2+ years working with Medicare contracts and regulatory reporting requirements.
• 3+ years in managed care or medical insurance.
• 2+ years working in a clinical setting.
• 1+ year in a claims, customer service, or provider support role.
• Excellent oral and written English communication skills, including telephone etiquette.
• Superior interpersonal skills.
• Proficient research, critical-thinking, and analytical problem-solving skills.
• Intermediate proficiency with Microsoft Office (Excel, Word, PowerPoint, Outlook).
• Self-starter and resourceful with the ability to execute projects in a fluid and fast-paced environment.
• Strong organizational, planning, and attention-to-detail skills.
• Valid Driver’s License, reliable transportation, and proof of insurance required.
• Requires local travel and occasional out-of-area overnight travel.

Benefits

• Loan Forgiveness Program
• Challenging and rewarding work environment
• Competitive compensation and generous paid time off
• Excellent medical, dental, vision, and prescription drug plans
• 401(K) with company match and discounted stock plan
• SoFi Student Loan Refinancing Program
• Career development opportunities within UHS and its 300+ subsidiaries

More information is available on the Benefits Guest Website.