Are you looking for the next steps in your career? Take that first one by applying to be a Provider Performance Specilist II. If you have a positive, professional demeanor and understand the importance of making and keeping loyal customers happy, this opportunity is perfect for you! The ideal candidate has previous experience in managed care or for a large provider group.
Provide consultative support to providers to improve their performance on member outreach, utilization management, cost, quality and risk. Discuss, analyze and interpret performance reporting, member engagement data and other data resources to identify opportunities for improving member outcomes.Facilitate provider discussions regarding quality, utilization, and cost or risk performance improvement opportunities, utilizing corporate tools and reporting.Collaborate with health plan quality counterpart to ensure coordinated communication and goal alignment for provider discussions. Develop proficiency in tools and value based performance (VBP) and educate providers on the use of tools and interpretation of data.Present detailed HBR (Health Benefits Ratio) analysis and create reports for Joint Operating Committee meetings.
*** Must live in State of Ohio***
- Managed Care (2 years of experience is required)
- Analytical Thinking
- Account Management (2 years of experience is preferred)
- Policy and Procedure (2 years of experience is preferred)
- Claims Processing (2 years of experience is required)
- Medicare Compliance (1 year of experience is preferred)
- Health Plan Benefits (2 years of experience is required)
- Provider Relations (3 years of experience is required)
- Years of experience: 3 years
- Experience level:Experienced
Working hours: 8 AM - 5 PM
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