What are the responsibilities and job description for the Provider engagement position at TEKsystems?
Candidates can site anywhere in Maine
This position requires travel to provider offices in a 30 mile radius of where you live.
Description :
Position Purpose : Acts as a liaison between Tier II providers (large PCP groups not on risk contracts and providers with upside only incentives) and the health plan.
Manages Network performance for assigned territory through a consultative / account management approach. Drives provider performance improvement in the following areas : Risk / P4Q, Health Benefit Ratio (HBR), HEDIS / quality, cost and utilization, etc.
Evaluates provider performance and develops strategic plan to improve performance. Performs detailed HBR analysis. Facilitates provider trainings, orientations, and coaches for performance improvement within the network and assists with claim resolution.
Serve as primary contact for providers and act as a liaison between the providers and the health plan
Triages provider issues as needed for resolution to internal partners
Receive and effectively respond to external provider related issues
Investigate, resolve and communicate provider claim issues and changes
Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
Perform provider orientations and ongoing provider education, including writing and updating orientation materials
Manages Network performance for assigned territory through a consultative / account management approach
Drives provider performance improvement in the following areas : Risk / P4Q, Health Benefit Ratio (HBR), HEDIS / quality, cost and utilization, etc.
Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)
Develop proficiency in tools and value based performance (VBP) and educate providers on use of tools and interpretation of data
Coaches new and less experienced External Reps
Completes special projects as assigned
Ability to travel locally 4 days a week (30 mile radius of home location)
Skills :
provider relations, provider claims / reimbursement, Managed Care contracting, Medicare, Medicaid, medical terminology
Additional Skills & Qualifications :
Education / Experience : Bachelors degree in related field or equivalent experience. Three years of provider relations, provider claims / reimbursement, or contracting experience.
Knowledge of health care, managed care, Medicare or Medicaid. Bachelors degree in healthcare or a related field preferred.
Claims billing / coding knowledge preferred. Perform provider orientations and ongoing provider education, including writing and updating orientation materials
Evaluates provider performance and develops strategic plan to improve performance
Drives provider performance improvement in the following areas : Risk / P4Q, Health Benefit Ratio (HBR), HEDIS / quality, cost and utilization
Project Management / Lead
Time management / Great Organization skills
About TEKsystems :
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity.
We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia.
As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change.
That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
Last updated : 2024-02-23
