Provider Engagement Specialist III

About This Role

This role is responsible for provider contracting services, provider assistance, and acts as the engagement lead for high-value, strategic health partners in North Eastern Mississippi. The specialist will drive network performance, new products, and product expansion.

Responsibilities

• Execute quality, engagement, and contracting strategy for the assigned Market
• Lead identified Market performance and engagement strategic initiatives
• Support overall network performance, new products, and product expansion
• Recruit providers, contract, and initiate loading and credentialing processes
• Coordinate account strategy and provide support to drive satisfaction and engagement of Provider network
• Negotiate and re-negotiate hospital, ancillary, physician, and behavioral health contracts, terms, and reimbursement rates
• Analyze financial data to establish network strategic initiatives, partnerships, and rates
• Drive quality outcomes through execution and support of Value Based Reimbursement agreements
• Assume leadership role in JOC's (Joint Operating Committees) with key health partners
• Provide on-site practice transformation support and education to Providers in the CareSource PCMH program
• Mentor and/or train new hires

Requirements

• Bachelor’s degree in a healthcare related field or equivalent years of relevant work experience
• 5+ years of healthcare experience
• 3+ years of direct work experience in provider relations and/or provider contracting
• Managed care experience
• Intermediate proficiency with Microsoft Outlook, Word, and Excel
• Knowledge of Provider Network Management Processes & Services
• Ability to manage and prioritize multiple tasks
• Strong negotiation skills
• Effective oral and written communication skills
• Critical listening and thinking skills
• Training/teaching skills
• Time management skills

Qualifications

• Bachelor’s degree in a healthcare related field, or equivalent years of relevant work experience is required
• Minimum of five (5) years of healthcare experience, to include three (3) years of direct work experience in provider relations and/or provider contracting. Managed care experience is required.

Nice to Have

• Master’s Degree
• NCQA PCMH experience
• Six Sigma Certification
• Project Management certification

Skills

* Required skills

Benefits