Medicare Star Provider Relations Specialist

Job Number: 1827

Workplace Type:

Position Title: Medicare Star Provider Relations Specialist

External Description:

The Medicare Star Provider Relations Specialist (MSPSR) is responsible for providing Medicare Star/HEDIS and Risk Adjustment support and training. This position serves as a liaison between Alignment Health plan and medical office staff. The MSPSR will function as the single point-of-contact for all on-going Medicare Star, HEDIS and Risk Adjustment issues as needed by providers and is responsible for timely and professional interaction with internal and external customers.

General Duties/Responsibilities:
(May include but are not limited to)
1. Facilitate provider and office staff education and training in order to increase their familiarity and satisfaction with Alignment’s systems and strategies, including training and education on HEDIS data submission and HEDIS, Stars, Risk Adjustment and clinical initiatives.
2. Enhance the relationship with providers and office staff by conducting timely, effective routine and follow up visits to provider offices, participating in provider orientations, Joint Operations Committee meetings, with appropriate information sharing, by efficiently and effectively responding to requests for information, by monitoring and influencing physician growth opportunities and trends, and by successfully resolving issues.
3. Set targets and priorities in order to meet national HEDIS/Star, Risk Adjustment and market-specific Medicare Star Program(s) needs. Research issues related to measures not meeting benchmark and drive internal resolution.
4. Connects meaningfully with customers to build emotional engagement and customer advocacy. Simplifies complexity and integrates internal efforts to deliver an optimal customer service experience.
5. Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints.
6. Engages others by gathering multiple views and being open to diverse perspectives.
7. Maintain Provider contact database.
8. Assists provider groups in securely submitting supplemental data source information via Secure File Transfer Protocols (sFTP).

Minimum Requirements:

•Associates degree required or related job experience, or 3 years healthcare related experience in lieu of a degree.
•1+ years of HEDIS, Medicare Star program and or Risk Adjustment
•Experience reconciling data discrepancies, and encounter submission errors between provider and healthcare plan
•Exceptional customer service skills
•Working knowledge of healthcare provider business operations
•Knowledge of healthcare, managed care, Medicare
•Strong communications skills: written, verbal, and interpersonal
•Intermediate to Advanced computer skills

Preferred Qualifications:
•Bachelor’s degree
•5+ years HEDIS and Medicare Star program experience and or Risk Adjustment
•Experience with data analytics

The job description is not intended to be an exhaustive list of all functions and responsibilities of the
position. Employees are held accountable for all of the functions of the job. Job duties and the % of time
identified for any function are subject to change at any time.

Conditions of Work:
• Office Hours: Monday-Friday, 8am to 5pm. Extended work hours, as needed.
• 60% or more travel by car routinely required.
• Maintain reliable means of transportation. If driving, must have a valid driver’s license and automobile insurance.

 

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Medicare Star Provider Relations Specialist

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].