Under the direction of the Director, Provider Network Management, the Practice Management Consultant provides education, training and guidance for providers in the assigned provider network; drives quality discussions to increase member care, member satisfaction and provider satisfaction, responsible for performing on-site reviews of new and re-credentialed providers within their assigned territory; identify and educate providers requiring additional education (performed on-site, via conference call and/or via webinar).

Required:

• College degree or 3-4 years’ experience in a physician’s office, payer agency, community agency or other health care environment.
• Valid driver’s license.
• Previous customer service experience with exposure to claims and benefits interpretation and provider networking.
• Knowledge of medical coding.
• Knowledge of HEDIS® and Star Ratings.
• Computer experience with Microsoft Word, Excel, Power Point and Outlook.

Desired:

• Strong verbal and written communication skills with the ability to communicate (oral and written) effectively.
• Strong project management skills.
• Must be able to perform presentations for small and large audiences in person and remotely.
• Organizational skills with the ability to handle multiple tasks and/or projects at one time.
• Customer service skills with the ability to interact professionally and effectively with providers, and staff.
• Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time.
• Problem resolution skills.
• Ability to work under little supervision and act as a team member.
• Familiar with current managed care, State and/or Federal healthcare programs (Medicare, Medicaid) and the insurance industry.
• Experience in managed care, State and/or Federal health programs.
• Certified Medical Insurance Specialist.
• Value based reimbursement/initiatives/projects experience.

Responsibilities:

• Held accountable for servicing providers within their assigned territory.
• Evaluate and monitor providers’ performance standards and financial performance of contracts as requested to support THP goals.
• Make regular visits, in-person, by phone and/or video call, to providers and act as primary resource for driving quality, operational efficiency and membership growth and retention.
• Travel throughout assigned geographic area, as required.
• Ability to cover a large geographic area.
• Outreach to contracted provider offices to educate as necessary.
• Knowledge of standard credentialing procedures.
• Communicate changes and updates to providers.
• Assist other departments with outreach to contracted provider offices as needed.
• Identify workflow processes and training to develop target initiatives to improve quality reporting.
• Facilitate contracted provider meetings.
• Familiar with all product lines, including education on billing services necessary to enhance company initiatives.
• Assist management in provider and quality reporting requirements.
• Regularly attend conferences and webinars to expand knowledge base.
• Train and offer technical assistance to providers for all THP applications.
• Work directly with clinical data and analytics team to track service trends and educate providers.
• Implement and coordinate programs to build and nurture relationships between THP, providers and office managers.
• Coordinate with Quality Improvement team to complete quality and department initiatives.