Physician Performance Representative (Hybrid)

***This position is REQUIRED to be bilingual in Spanish and English***

Job Summary: The Provider Relations Representative is responsible for playing a crucial role in cultivating, nurturing, and enhancing a provider network within an assigned geographical area; and collaborating closely with assigned providers to enhance overall performance across key performance indicators.

Requirements:

• 5 years of experience in a healthcare-related position, preferably in a managed care environment, and/or bachelor’s degree in a health-related field or Business Administration or equivalent combined experience.
• 3 years' experience in Provider Relations, Network Management, Contracting, Credentialing.
• Prior experience and/or knowledge of HEDIS, CMS Star Rating System, ACO Operations, and/or Medicare Risk Adjustment is required.
• Must have a valid Driver's license, clean driving record, and reliable transportation - this position requires driving within Miami-Dade and Broward counties.
• Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access, and PowerPoint). Must be moderate to advanced in Excel.
• Demonstrated experience with Network development and performance management.
• Prior experience and/or knowledge of CMS and Medicare Advantage payment methodologies, and Value-Based Contracting is preferred.

Essential Duties and Responsibilities:

• Delivers comprehensive education to providers, providing them with the necessary tools to meet Quality, Risk Adjustment, Growth (as applicable), and Total Medicare Cost goals outlined in business development plans.
• Understands the financial performance and overall profitability of each Practice and assumes accountability for overall performance, and profitability.
• Ensures providers possess a thorough comprehension of contractual obligations. Responsible for communicating and reviewing ongoing performance against Key Performance Indicators, such as HCC recapture rate, Stars performance, MLR, and other crucial clinical outcomes, with actionable steps for improvement.
• Conducts comprehensive new provider orientations and ongoing educational sessions for providers and their staff, covering healthcare delivery products, health plan partnerships, processes, and patient care plans.
• Ensures that the organization is meeting provider retention goals, and minimizing provider attrition, which are primarily driven by provider satisfaction.
• Facilitates regular provider meetings to disseminate economic data and troubleshoots issues aimed at enhancing patient outcomes and operational efficiencies.
• Coordinates and facilitates Joint Operational Committee meetings where applicable, to align strategies and goals.
• Develops, implements, and monitors performance improvement plans for assigned groups.
• Negotiates proposed modifications to existing contact capitation rates and works with leadership to analyze such proposals and make informed decisions.
• Integrates strategic interventions via cross-departmental collaboration to enhance overall effectiveness and performance.
• Performs other related duties as assigned.