Provider Engagement Specialist Riverside County

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Provider Engagement Specialist supports the performance and growth objectives of the market pod by engaging with network primary care and specialist providers. Supports network growth through outreach and contracting with prospective providers. This role also involves supporting day-to-day network operations.

Job Duties

1.    Develops collaborative relationships with key providers, provider office staff, and other downstream entities to promote growth and improve performance benchmarks.
2.    Conducts initial provider orientations and provide support for ongoing provider educational outreach (direct networks).
3.    Conducts outbound follow up to providers in order to resolve access to care issues.
4.    Assist in the development of training and educational materials/tools. Create Provider in-service packets and implementation packets. Coordinate, conduct, and/or initiate Model of Care Trainings for external providers.
5.    Utilizes department databases and tracking mechanisms to ensure all key departmental processes are met. Update and maintain accurate information in Sales Force. 
6.    Creates distribution lists for various email notifications and campaigns.
7.    Understands Managed Care operations, Risk Adjustment, and HEDIS measures
8.    Educates, Facilitates, and operates as “one touch resolution” or primary contact for resolution to provider inquiries related but not limited to UM, Claims, Eligibility, contracting, directory validation, etc.
9.    Negotiates and implements standard agreements with physicians and ancillary providers in existing and developing markets.
10.    Obtains provider credentialing information and prepare supporting contract documentation for contract implementation.
11.    Utilizes network database to track both provider recruitment activity and executed contracts.
12.    Maintains weekly summary of activity and submits report on a weekly basis.
13.    Attends and participates in all staff meetings as required.
14.    Performs special projects as assigned to help drive leads for the company.

Job Requirements:

Experience:

• Required: Minimum one year of experience in provider relations / contracting with an HMO or IPA, medical group or institutional provider required

• Preferred: 2 years of experience in field.

Education:

• Required: High School Diploma or GED.  Bachelor's degree or four years additional experience in lieu of education.

• Preferred: MBA

Training:

• Required:

• Preferred:

Specialized Skills:

• Required:

• Proficient user in MS office suite (Word, Excel and PowerPoint).
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
• Mathematical Skills:  Ability to perform mathematical calculations and calculate simple statistics correctly
• Reasoning Skills:  Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
• Problem-Solving Skills:  Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Report Analysis Skills:  Comprehend and analyze statistical reports.

Licensure:

• Required: Valid Drivers License

• Preferred:

Other:

• 80% or more travel by car routinely required (In assigned market).
• Travel by plane required as needed.
• Maintenance of reliable means of transportation and valid driver’s license and automobile insurance required.
• Extended works hours, as needed.
• Remote work on approval.

Work Environment:

The work environment characteristics described here are representative of those an

employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.  While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $58,531.00 - $87,797.00

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.

Salary : $58,531 - $87,797