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Hawaii Medical Service Association

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Provider Engagement Manager

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Description

  1. Provider Pod Leadership
    • Lead recurring Provider Pod meetings for assigned provider organizations.
    • Develop meeting agendas and facilitate productive discussions.
    • Coordinate participation from internal subject matter experts.
    • Track action items and ensure accountability for completion.
    • Aggregate data with the Senior Financial Analyst and the Senior Data Analyst.
      • Present findings in the POD meetings to rank-and-file providers.
  2. Value-Based Performance Management
    • Lead performance reviews and action planning related to:
      • Revenue cycle optimization and issue resolution
      • Medicare STAR quality gap closure opportunities
      • Risk Adjustment Factor (RAF) optimization
      • Suspect condition validation and documentation improvement
      • HCC coding opportunities
      • Cost of care reduction initiatives
      • Emergency Department utilization
      • Hospital admissions
      • Readmission reduction
      • Specialist referral optimization
      • Preventive care performance
      • Clinical quality measures
  3. Provider Relationship Management
    • Build trusted relationships with physician leaders and practice administrators.
    • Serve as the primary strategic liaison between the (provider organization / IPAs / Systems / ACOs) and the MSO.
    • Identify operational barriers impacting provider performance.
    • Coordinate internal resources to resolve provider concerns.
    • Promote adoption of MSO programs, tools, and best practices.
  4. Performance Improvement
    • Analyze provider performance trends.
    • Develop action plans to improve financial and clinical outcomes.
    • Monitor progress toward established performance goals.
    • Present performance dashboards and recommendations.
  5. Cross-Functional Collaboration
    • Partner with teams responsible for:
      • Revenue Cycle
      • Clinical Operations
      • Care Management
      • Coding and Documentation
      • Quality Improvement
      • Provider Contracting
      • Population Health
      • Analytics
      • Pharmacy
      • Network Operations
  6. Performs all other miscellaneous responsibilities and duties as assigned or directed.

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