Provider Support Specialist

POSITION SUMMARY:

Provide utilization oversight, MRA and HEDIS support with a goal of helping physician offices to gain and maintain profitability for Healthy Partners owned and affiliate offices.

ESSENTIAL DUTIES:

• Building relationships with providers and staff
  1. Through consistent phone calls and office visits (re: utilization information review, system training, customer service related inquiries, sharing current and relevant information, etc.)
  2. Frequent travel to office locations
  3. Effect change and produce positive results for Healthy Partners and PCP office to strengthen and support long term successful relationship.
  4. Overcome roadblocks and resistance to change through effective and consistent communication
• Utilize HP Analytics to review pertinent utilization data and educate providers and provider’s staff on utilization and correct application of best practices
  1. Understand and explain existing reports and provide new reports and tools, as needed
  2. Provide HP Analytics system training to provider and staff
• Work with MRA and HEDIS team to ensure MRA coding is being documented appropriately and HEDIS gaps are being closed
  1. Communicate information to all (PCP and PCP staff, HEDIS, MRA, etc. regarding progress and deficiencies)
  2. Develop strategies for improving all aspects of market performance including MRA, HEDIS and Medical management
  3. Support provider and staff in closing MRA and HEDIS gaps
• Assist Healthy Partners in the oversight of membership growth strategies
  1. Identify membership trends
  2. Identify patients that my benefit from a Medicare Advantage Plan
  3. Communicate with business development team to provide support and data relevant to membership growth goals

REQUIREMENTS:

• Bachelor’s degree in related field or equivalent work experience preferred
• 3-5 years of health care experience, preferably working with Medicare
• 1-2 years EMR/EHR system experience
• Problem solving skills
• Ability to build and maintain relationships
• Superb attention to detail
• Organization and time management skills
• Self-motivated
• Excellent written and verbal communication skills
• Microsoft suite (Excel, Word and PowerPoint) experience

PHYSICAL DEMANDS

This work requires light to medium physical exertion. The working conditions associated with the performance of this job are characteristic of those found in a normal office environment. Position will require travel within region assigned. Hazards include potential exposure to blood- and/or airborne biological pathogens and infectious diseases.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job. Duties, responsibilities, and activities may change at any time with or without notice.

Healthy Partners provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.