The Provider Engagement Professional 2 represents the scope of health plan/provider relationship across such areas as financial performance, clinical management, data sharing, connectivity, documentation and coding, operational improvements and other areas as they relate to provider performance, member experience, market growth, provider experience and operational excellence. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.
1-5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience
Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies
Demonstrated ability to manage multiple projects and meet deadlines
Bachelor’s or Masters Degree
Proficiency in analyzing and interpreting claims trends for health care costs, administrative expenses and quality/bonus performance
Comprehensive knowledge of Medicaid policies, processes and procedures
Scheduled Weekly Hours