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.

Competencies

• Experience in provider relations, provider services, managed care, healthcare operations, or quality improvement preferred. 
• Working knowledge of health plan operations, including claims, authorizations, referrals, credentialing, contracting, utilization management, and quality improvement programs. 
• Strong written and verbal communication, interpersonal, relationship-management, organizational, and problem-solving skills. 
• Ability to independently manage multiple provider relationships, priorities, and competing deadlines in a dynamic, fast-paced environment. 
• Ability to establish and maintain effective professional relationships while demonstrating professionalism, confidence, sound judgment, and sincerity. 
• Strong planning, time-management, and follow-through skills, with excellent attention to detail and the ability to maintain accurate, complete, and timely documentation. 
• Ability to work effectively both independently and collaboratively within a team environment to achieve departmental and organizational objectives. 
• Ability to provide and receive constructive, job- and industry-related feedback in a professional manner. 
• Ability to exercise sound discretion, maintain confidentiality, and appropriately handle sensitive information on a need-to-know basis. 
• Demonstrated commitment to delivering excellent customer service and representing the Company in a professional manner. 
• Demonstrated commitment to the organization’s mission, values, and service standards. 
• Intermediate proficiency in Microsoft Word, Excel, PowerPoint, Visio, and email applications. 
• Ability to quickly learn and effectively utilize new software, technology, and healthcare-related systems. 
• Typing speed of 40 words per minute or greater preferred.

Education and Licensure

• High School Diploma or GED minimum.
• Bachelor's degree in healthcare administration, business, public health, nursing, or a related field preferred; equivalent relevant experience may be considered.
• Active and unrestricted Driver’s License 

Salary : $70,304 - $85,000