Job Description

Job Description

Job Description

Under the direction of the Director, Provider Network Management, the Practice Management Consultant provides education, training and guidance for providers in the assigned provider network; drives quality discussions to increase member care, member satisfaction and provider satisfaction, responsible for performing on-site reviews of new and re-credentialed providers within their assigned territory; identify and educate providers requiring additional education (performed on-site, via conference call and/or via webinar).

Required:

1. College degree or 3-4 years’ experience in a physician’s office, payer agency, community agency or other health care environment.
2. Valid driver’s license.
3. Previous customer service experience with exposure to claims and benefits interpretation and provider networking.
4. Knowledge of medical coding.
5. Knowledge of HEDIS® and Star Ratings.
6. Computer experience with Microsoft Word, Excel, Power Point and Outlook.

Desired:

1. Strong verbal and written communication skills with the ability to communicate (oral and written) effectively.
2. Strong project management skills.
3. Must be able to perform presentations for small and large audiences in person and remotely.
4. Organizational skills with the ability to handle multiple tasks and/or projects at one time.
5. Customer service skills with the ability to interact professionally and effectively with providers, and staff.
6. Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time.
7. Problem resolution skills.
8. Ability to work under little supervision and act as a team member.
9. Familiar with current managed care, State and/or Federal healthcare programs (Medicare, Medicaid) and the insurance industry.
10. Experience in managed care, State and/or Federal health programs.
11. Certified Medical Insurance Specialist.
12. Value based reimbursement/initiatives/projects experience.

Responsibilities:

1. Held accountable for servicing providers within their assigned territory.
2. Evaluate and monitor providers’ performance standards and financial performance of contracts as requested to support THP goals.
3. Make regular visits, in-person, by phone and/or video call, to providers and act as primary resource for driving quality, operational efficiency and membership growth and retention.
4. Travel throughout assigned geographic area, as required.
5. Ability to cover a large geographic area.
6. Outreach to contracted provider offices to educate as necessary.
7. Knowledge of standard credentialing procedures.
8. Communicate changes and updates to providers.
9. Assist other departments with outreach to contracted provider offices as needed.
10. Identify workflow processes and training to develop target initiatives to improve quality reporting.
11. Facilitate contracted provider meetings.
12. Familiar with all product lines, including education on billing services necessary to enhance company initiatives.
13. Assist management in provider and quality reporting requirements.
14. Regularly attend conferences and webinars to expand knowledge base.
15. Train and offer technical assistance to providers for all THP applications.
16. Work directly with clinical data and analytics team to track service trends and educate providers.
17. Implement and coordinate programs to build and nurture relationships between THP, providers and office managers.
18. Coordinate with Quality Improvement team to complete quality and department initiatives.

Equal Opportunity Employer

The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

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