Medicare Star Provider Relations Specialist
Location: Orange, California US
Job Number: 1827
Position Title: Medicare Star Provider Relations Specialist
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.
(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).
•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
•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.
Location City: Orange
Location State: California
Community / Marketing Title: Medicare Star Provider Relations Specialist
Who is Alignment Healthcare?
- Socially responsible
- Technologically enabled
- Concierge care
- Servant leadership
We are dedicated to transforming the complex and confusing process of medical treatment in the United States so that every link in the health care continuum becomes more efficient, productive, and effective. We built a team of people who want to make a difference. Come join the team that is changing health care one person at a time.
We believe that great work comes from people who are inspired to be their best. We invite you to explore our wide variety of roles based on your unique experience.
EEO Employer Verbiage:
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact email@example.com.