Are you a friendly and motivated individual who loves working in a fast paced environment? If so, we are looking for a multifaceted individual who can successfully multi-task the day to day responsibilities of a Provider Relations Specilist II. We are looking for someone who is comfortable on the phone, has great computer skills, is organized with the ability to multitask in a busy enviorment.
Interpret performance data, prioritizing insights and developing discussion and presentation documents, including year-to-date results, month-over-month performance, and member engagement results
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
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.
- Written Communication
- Decision Making
- Working Independently
- Benefits Administration
- Problem Solving
- Customer Service
- Answering Phones
- Handling Confidential Information
- Years of experience: 2 years
- Experience level:Experienced
Working hours: 8 AM - 5 PM
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