Provider Relations Specialist - Queens Territory

Position Summary

The Provider Relations Specialist is the mission-critical linchpin between HealthCare Partners and our network of primary care physicians. This role focuses on fostering strong working relationships with PCPs and staff in an ongoing effort to advance HCP’s organizational objectives, facilitate value based care, and improve both provider satisfaction and member health.

Essential Position Functions/Responsibilities

• Establish and maintain collaborative relationships with PCPs and their staff through regular touchpoints, acting as the primary liaison between HCP and the provider network.
• Educate providers on HCP’s value-based care model, ensuring alignment with organizational goals and objectives.
• Spend approximately 90% of scheduled work time conducting face-to-face provider office visits.
• Provider Relations Specialists are expected to spend approximately 4.5 days each week in the field, with approximately 0.5 day reserved for administrative responsibilities, including scheduling, documentation, reporting, and internal meetings, based on business needs.
• Proactively identify and address provider concerns, leveraging data and analytics to tailor strategic action plans.
• Serve as a point of contact on provider relations, offering guidance to internal teams and stakeholders.
• Provide strategic insights and recommendations to providers on optimizing performance in key metrics such as HEDIS, HCC, and STAR ratings.
• Collaborate with cross-functional teams—including Quality, Risk Adjustment, and Care Management—to drive performance improvement and ensure seamless provider support.
• Continuously evaluate processes and recommend improvements to enhance provider relations and streamline operational workflows.
• Maintain up-to-date knowledge of industry regulations, trends, and payer policies to provide informed guidance to providers.

Qualification Requirements

• Skills, Knowledge, Abilities:
• Establish and maintain collaborative relationships with PCPs and their staff through regular touchpoints, acting as the primary liaison between HCP and the provider network.
• Educate providers on HCP’s value-based care model, ensuring alignment with organizational goals and objectives.
• Spend approximately 90% of scheduled work time conducting face-to-face provider office visits.
• Provider Relations Specialists are expected to spend approximately 4.5 days each week in the field, with approximately 0.5 day reserved for administrative responsibilities, including scheduling, documentation, reporting, and internal meetings, based on business needs.
• Proactively identify and address provider concerns, leveraging data and analytics to tailor strategic action plans.
• Serve as a point of contact on provider relations, offering guidance to internal teams and stakeholders.
• Provide strategic insights and recommendations to providers on optimizing performance in key metrics such as HEDIS, HCC, and STAR ratings.
• Collaborate with cross-functional teams—including Quality, Risk Adjustment, and Care Management—to drive performance improvement and ensure seamless provider support.
• Continuously evaluate processes and recommend improvements to enhance provider relations and streamline operational workflows.
• Maintain up-to-date knowledge of industry regulations, trends, and payer policies to provide informed guidance to providers.
• Training/Education:
• Bachelor’s degree in healthcare, business administration or equivalent working field experience, required.
• Non-Bachelor’s degree in clinical discipline considered.
• Two or more years’ experience in HMO, IPA or medical group, Physician Management Company, or other managed care organization.
• Consulting or Account Management experience considered.

Training/Education

• Bachelor’s degree in healthcare, business administration or equivalent working field experience, required.
• Non-Bachelor’s degree in clinical discipline considered.
• Two or more years’ experience in HMO, IPA or medical group, Physician Management Company, or other managed care organization.
• Consulting or Account Management experience considered.

Benefits

• Fully paid Medical & Dental employee coverage + robust benefits package (PTO, 401k, FSA, Tuition Reimbursement, etc.)

Department

Network Relations

Employment Type

Full Time