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 is responsible for developing and maintaining strong relationships with provider offices to improve network performance, enhance provider satisfaction, and support organizational growth. This role partners with providers on strategies to increase patient retention and growth, while also driving performance across key quality and utilization metrics. The Provider Engagement Specialist serves as the main point of contact for providers, offering education, support, and tools to achieve goals.General Duties/Responsibilities (May include but are not limited to):Build and maintain collaborative relationships with providers and their staff to support growth, retention, and performance improvement.Partner with providers to improve performance on key performance indicators (KPIs), including but not limited to growth, retention, Annual Wellness Visits (AWVs), HEDIS gap closures, hospital and ER utilization, risk adjustment and other quality indicators.Conduct initial provider onboarding and provide support for ongoing provider education on Alignment tools, clinical programs, PCP incentives, Member benefit offerings, Model of Care and other compliance requirements, and Alignment initiatives.Assist in the development of training and educational materials/tools. Create provider in-service and implementation packets.Facilitate and serve as a single point of resolution for provider issues, including but not limited to UM, prior authorization, claims, encounter data, eligibility, provider rosters and directory validation.Represent Alignment Health at provider meetings, trainings, and community events. Document meeting minutes and action items as needed.Consistently utilize, update and maintain department databases and tracking tools to ensure provider engagement activities, provider visits and outcomes are documented and monitored.Negotiate and implement standard physician and ancillary agreements; obtain provider credentialing; utilize network database to track recruitment activity.Maintain weekly summary of activity and submit reports on a weekly basis.Attend and participate in all staff meetings as required.Perform special projects as assigned.Minimum Requirements:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are
21 days ago