Provider Practice Performance Advisor

Role Overview: The Performance Practice Advisor is part of the POD support model and provides support to the Provider Network Management team and Provider Network responsible for producing and presenting performance reports, VBC models, care coordination effectiveness and practice efficiencies.


Work Arrangement:


+ Remote – This position is fully remote.The Associate must visit provider offices and attend in-person meetings at our Delaware (DE) office.


Responsibilities:


+ Produce all quality and performance related reporting establishing opportunities and strategies regularly in preparation for JOC’s.

+ Interpret claims data and connections to patient outcomes and utilization trends.

+ Interprets utilization trends, optimizing performance based on state driven quality improvement programs i.e. HEDIS.

+ Attends meetings with providers to review gaps in care and developing plan of action with the provider to address these gaps in conjunction with PNM and CMO as applicable.

+ Supports network and quality strategy.

+ Implements and provides oversight of performance related projects as corporate best practices and strategy have identified.

+ Uses data and analysis tools to identify opportunities for improved performance and collaborates with peers to develop intervention strategies of which can be applied to theprovider action plans.

+ Conducts meetings with providers to review performance data and discuss areas of opportunities to strengthen provider partnerships in conjunction with PNM and CMO as applicable.

+ Tracks and prepares reports on action plans and outcomes of initiatives that advance provider VB performance per year.

+ Provides cross functional collaboration with PNO, PNM, and Quality program to achieve goals and objectives.

+ May assist with scheduling appointments for members and attend member outreach meetings in addition to provider meetings.

+ Value-based contracts with providers as it relates to HEDIS, withhold measures, TCOC performance metrics and other quality-based programs.

+ General Operational Knowledge related to provider satisfaction, education and communication with a fundamental understanding of operational items such as claims coding, payment integrity, provider data, credentialing, appeals disputes etc. applicable to State, Federal and STARS standards to ensure compliance.


Education & Experience:


+ Bachelor’s degree in healthcare administration or similar field.

+ 5 or more years of experience if no bachelors’ degree.

+ 3 or more years of Account Executive experience, total cost of care, and understanding of reimbursement methodologies to include risk or VB contracting.

+ Understand quality and provider performance reporting and HEDIS or other quality measures.

+ Healthcare regulations, reimbursement models and quality measures.

+ Possesses strong analytical skills to interpret and prepare provider performance data.


Licensure:


+ Valid driver’s license, car insurance, and reliable transportation
As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.