Provider Services Representative- Triad Region North Carolina

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

Position Summary:

The Provider Services Representative will assist in building strategic and collaborative partnerships with physicians and their office staff.   The PSR will function as the single point-of-contact for all on-going operational and service 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):

·       Facilitate provider and office staff education and training in order to increase their familiarity and satisfaction with Alignment Healthcare’s systems and strategies, including training and education on claims/encounter data submission, referral management system, RAF/HCC coding, HEDIS, Stars and clinical initiatives.

·       Enhances 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 related to capitation, claims, and other operational functions.

·       Set targets and priorities in order to meet national and market-specific network needs.

·       Maintain internal awareness of network changes by issuing timely and accurate provider update communications about provider changes, terminations, additions, and panel closures.

·       Customer Focus: Connects meaningfully with customers to build emotional engagement and customer advocacy.  Simplifies complexity and integrates internal efforts to deliver an optimal customer services experience.

·       Executes for Results:  Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints. 

·       Collaborates:  Engages others by gathering multiple views and being open to diverse perspectives, focusing on a shared purpose that puts Alignments Healthcare’s overall success first.

·       Supports improvement in risk-adjusted revenue by overseeing encounter data submission volume and HCC capture,  coordinating and providing information and/or training providers where deficiencies are identified.

·       Supports department efforts and Provider Relations Manager by participating in interdepartmental meetings and selected committees.

·       Contributes to team effort by accomplishing related results as needed.

Supervisory Responsibilities:

N/A

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.       Minimum Experience:

a.       Minimum 2+ years’ experience in provider relations, managed care or a physician’s office.

2.       Education/Licensure:

a.       Bachelor’s Degree preferred.

3.       Other:

a.       Strong analytic, quantitative, and problem-solving skills required.

b.       Strong verbal and written communication skills required.

c.       Strong presentation skills and ability to appropriately and effectively address diverse audiences required.

d.       Proficiency in MS Word and Excel required; Access database proficiency preferred.

e.       Work Conditions:

                                                               i.      Office Hours:  Monday-Friday, 8am to 5pm.  Extended work hours, as needed.

                                                             ii.      60% or more travel by car routinely required.

                                                           iii.      Travel by plane required as needed to support provider services needs in other geographies.

                                                           iv.      Maintain reliable means of transportation. If driving, must have a valid driver’s license and automobile insurance.

                                                             v.      Remote work at home and must live in the Triad region of North Carolina

4.       Work Environment:

1. 1. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.