Star Provider Relations Specialist

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 Medicare Star Provider Relations Specialist is responsible for providing Medicare Star/ Healthcare Effectiveness Data and Information Set (HEDIS) support and training for direct providers and contracted provider groups. This position serves as a liaison between Alignment Health plan and IPA/MSO partners. Functions as the single point-of-contact for all on-going Medicare Star, HEDIS, and Consumer Assessment of Healthcare Providers and Systems (CAHPS) issues as needed by providers and is responsible for timely and professional interaction with internal and external customers.

GENERAL DUTIES/RESPONSIBILITIES :
1.    Facilitates IPA and MSO education and training in order to increase their familiarity and satisfaction with Alignment’s systems and strategies, including training and education on Star including: HEDIS, HEDIS data submission, CAHPS and clinical initiatives.
2.    Facilitates provider and office staff education and training to increase their familiarity and satisfaction with Alignment’s systems and strategies, including training and education on CAHPS, HEDIS, and HOS as well as Star and clinical initiatives.
3.    Sets targets and priorities to meet national HEDIS/Star and market-specific Medicare Star Program needs.  Researches issues related to measures not meeting benchmark and drive internal resolution. 
4.    Connects meaningfully internal departments to build emotional engagement and customer advocacy. Simplifies complexity and integrates internal efforts to deliver an optimal HEDIS/Star performance organizationally. 
5.    Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints. 
6.    Engages others by gathering multiple views and being open to diverse perspectives. 
7.    Assess IPA and MSO performance and provide actionable items to increase performance in underperforming areas.
8.    Maintains and builds meaningful relationships with IPA and MSO partners to facilitate cooperation and collaboration. 
9.    Implements performance related campaigns throughout the year that target specific areas of STAR performance.
10.    Serves as primary point of contact for IPA and MSO data exchange communication and manages quick resolutions to ensure quality of internal data.
11.    Researches any supplemental data exchange issues and correct them in a timely manner with IPA/MSO. 
12.    Other duties as assigned.

Minimum Requirements:

Experience:

• Required: Minimum 2 years of HEDIS and Medicare Star program. Minimum 2 years of experience reconciling data discrepancies, and encounter submission errors between provider and healthcare plan.

• Preferred: 4 years HEDIS and Medicare Star program experience

Education:

• Required: Bachelor's degree

Specialized Skills:

• Required:

• Working knowledge of healthcare provider business operations
• Knowledge of healthcare, managed care, Medicare
• 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 and automobile insurance

Other:

• Required:

• Office Hours: Monday-Friday, 8am to 5pm. Extended work hours, as needed.
• Up to 60% of travel by car routinely required.
• Travel by plane required as needed to support provider services needs in other geographies.
• Maintain reliable means of transportation. If driving, must have a valid driver’s license and automobile insurance.

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: $0.00 - $0.00

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.