SUMMARY:

The Provider Engagement Representative Assists in developing and managing the Medicare Advantage physician/provider network for assigned territory. Responsible for relationship management with assigned provider groups and their staff, as well as executing with provider group on initiatives that benefit the customer, provider, and health plan.

Requires at least 80% local travel to network providers
Coverage Area – metro-Atlanta area
Car & valid driver’s license required (mileage reimbursement provided)

RESPONSIBILITIES:

Responsible for assisting with the general oversight of provider network in assigned territory, to include financial performance, quality initiatives, provider data accuracy, trend analysis, and provider engagement (particularly PCPs and hospital partners).Responsible for collaborating with administrator on strategic plans on growth, development, and vision for assigned territory. Participates with manager in monthly financial review with senior management.
Expected to assist in managing key partner relationships for assigned territory. Develops and maintains relationships with physicians, providers, practice managers, and care coordination teams with health system/large clinic partners within the provider network to drive optimal performance on Stars, coding, utilization, and overall financial performance.

Responsible for ensuring provider updates are processed correctly and communicated back to necessary provider groups, as well as assistance with provider questions, grievances, and issues (claims, referrals, etc.)

MINIMUM QUALIFICATIONS:

• Bachelor’s degree required
• 3+ years of experience of Provider Network Operations experience required, preferably in managed care with proficient knowledge of negotiating and/or operating value-based agreement
• 3+ years of Healthcare experience required
• Must have the knowledge and business acumen to manage a health system or large provider entity relationship completely
• Strong problem solving and excellent communication skills required
• Proficient with Microsoft Office experience; strong Excel and Power Point experience needed
• Experience delivering presentations to large groups
• Proficient in trend analysis and/or strong financial background.