[Hiring] Provider Practice Performance Advisor @Amerihealth Caritas

Role Description

The Performance Practice Advisor is part of the POD support model and provides support to the Provider Network Management team and Provider Network responsible for producing and presenting performance reports, VBC models, care coordination effectiveness and practice efficiencies.

Work Arrangement: Remote – This position is fully remote.

The Associate must:

• Produce all quality and performance related reporting establishing opportunities and strategies regularly in preparation for JOC’s.
• Interpret claims data and connections to patient outcomes and utilization trends.
• Interpret utilization trends, optimizing performance based on state driven quality improvement programs i.e. HEDIS.
• Attend meetings with providers to review gaps in care and develop a plan of action with the provider to address these gaps in conjunction with PNM and CMO as applicable.
• Support network and quality strategy.
• Implement and provide oversight of performance related projects as corporate best practices and strategy have identified.
• Use data and analysis tools to identify opportunities for improved performance and collaborate with peers to develop intervention strategies that can be applied to the provider action plans.
• Conduct meetings with providers to review performance data and discuss areas of opportunities to strengthen provider partnerships in conjunction with PNM and CMO as applicable.
• Track and prepare reports on action plans and outcomes of initiatives that advance provider VB performance per year.
• Provide cross functional collaboration with PNO, PNM, and Quality program to achieve goals and objectives.
• May assist with scheduling appointments for members and attend member outreach meetings in addition to provider meetings.
• Manage value-based contracts with providers as it relates to HEDIS, withhold measures, TCOC performance metrics and other quality-based programs.
• Possess general operational knowledge related to provider satisfaction, education and communication with a fundamental understanding of operational items such as claims coding, payment integrity, provider data, credentialing, appeals disputes etc. applicable to State, Federal and STARS standards to ensure compliance.

Qualifications

• Bachelor’s degree in healthcare administration or similar field.
• 5 or more years of experience if no bachelor’s degree.
• 3 or more years of Account Executive experience, total cost of care, and understanding of reimbursement methodologies to include risk or VB contracting.
• Understand quality and provider performance reporting and HEDIS or other quality measures.
• Knowledge of healthcare regulations, reimbursement models and quality measures.
• Possess strong analytical skills to interpret and prepare provider performance data.