Provider Engagement Administrator
Office Locations: Durham, Wilmington and Charlotte, NC / Homebased position
Position Purpose: Reporting to the Director of Provider Engagement, the Provider Engagement Administrator will serve as a liaison between the health plan and network providers, community partners and other stakeholders. This position is responsible for adding value to the network and plan through building and maintaining strong relationships with network providers and serving as a resource and support mechanism to promote the quadruple aim. As a key-member of a cross-functional, dynamic team, the Provider Engagement Administrator will serve as a key driver in supporting the PE goals of satisfaction, improved performance, advocacy and move to value.
Key Responsibilities
- Act as a liaison between the provider (Hospital Systems, AMH, Local Health Department and Specialists) and the health plan ensuring a coordinated effort in improving financial and quality performance
- Engage providers to solicit and build on their ideas/interests related to quality performance measurement
- Collaborate with Care Management, Quality and others across the Health Plan and Network
- Educate providers regarding policies and procedures related to referrals, claims submission, web site education, Electronic Health Records, Health Information Exchange, and Electronic Data Interface
- Engage providers on Advanced Medical Home / Patient Centered Medical Home initiatives.
- Conduct initial provider orientations as well as ongoing educational outreach for assigned providers
- Including but not limited to Portal use training including, CAP report retrieval, Quality Dashboards, Claims lookup, and more
- Identify and deliver solutions to solve significant problems for providers; quantify impact.
- Assist providers in achieving pay-for-performance milestones
- Generate and interpret reports for providers based on detailed HEDIS and/or HBR (Health Benefits Ratio) analysis and review provider performance by both quantitative metrics and qualitative factors
- Create and communicate milestone documents, dashboards and success metrics
- Provide status updates for providers regarding incentive agreements
- Conduct site visits to improve quality and financial outcomes
- Collaborate with the Medical Policy Department and others to support policy development and ongoing assessment through provider engagement and other means
- Protect confidential and sensitive business information, complying with Centene in NC firewall system, HIPPA, and CCHN partners
- Perform other duties as delegated
- May require up to 50% travel (local and overnight)
Preferred Skills and Qualifications
- Bachelor’s degree in related field preferred; or equivalent experience
- 3+ years of project management, provider relations, health care operations, or medical management
- Experience in Managed Healthcare or Medicaid/Medicare industry preferred
- Excellent written, oral, and presentation skills required
- Ability to work collaboratively with staff and contractors at all levels
- Well-developed organizational skills and attention to detail
- High proficiency with Microsoft Office products as well as communication productivity tools
- Ability to multitask, prioritize work and adapt to changing priorities
- Must be a self-starter and have a strong sense of urgency
- Should have a strong customer service mindset for supporting both and internal and external customers
- Current state driver’s license
Carolina Complete Health Network is an equal opportunity employer that is committed to diversity and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
