PROVIDER PRACTICE SUPPORT ADVISOR (3627)

Job Summary:

The Provider Practice Support Advisor serves as the primary liaison and relationship owner for an assigned portfolio of provider practices. The position supports provider engagement, education, quality improvement, and operational performance by coordinating resources and facilitating timely resolution of provider needs.

The Practice Support Advisor provides a consistent point of contact while partnering with Quality, Risk Adjustment, Clinical, Claims, Utilization Management, Credentialing, Contracting, Compliance, and other specialized teams that retain responsibility for their respective functions

Responsibilities:

• Serve as the primary relationship and coordination resource for assigned provider practices.
• Conduct provider meetings, outreach, education, and practice support activities.
• Support HEDIS, Stars, quality measures, care-gap closure, and other health plan or organizational initiatives.
• Review available provider performance information and communicate opportunities requiring provider action.
• Educate providers and office staff regarding health plan requirements, authorizations, referrals, claims processes, documentation, system tools, and operational workflows.
• Coordinate provider onboarding, orientation, system access, and training.
• Assist providers with operational issues involving claims, credentialing, contracting, utilization management, compliance, grievances, referrals, and authorizations.
• Route issues to the appropriate internal department and maintain provider communication and follow-through through resolution.
• Identify recurring provider barriers and escalate complex performance or workflow issues to the appropriate internal resource or Senior Practice Coach.
• Maintain accurate documentation of provider interactions, education, outstanding issues, and follow-up activities.
• Support provider satisfaction, engagement, and successful participation in organizational and health plan programs.
• Performs related duties consistent with the scope and intent of the position.
• Regular attendance.
• Travel as required.

Other Functions

• Enforces Company policies and safety procedures.
• Regularly updates job knowledge by participating in educational opportunities, reading professional publications, maintaining professional networks, and participating in professional organizations.
• Maintain IPA, Health Plan compliance standards.

Travel

• The incumbent may travel up to 50% of the time in the greater Sacramento Area.

Work Environment

This job operates in a professional office environment. This role routinely uses office equipment such as computers, phones, photocopiers, scanners and filing cabinets.