Hybrid Provider Relations Specialist for Value-Based Care

Astrana-Health-1; Houston (TX); Hybrid; USD 75,000 - 85,000; Full time

Job summary

Astrana Health is seeking a Market Provider Relations Specialist in Houston to serve as the primary liaison between Astrana Health and provider practices. You will support provider engagement, transformation, quality improvement, risk adjustment, and value-based care initiatives.

Ideal candidates will build relationships with physicians and office staff, analyze performance data, educate on HEDIS and CMS Star Ratings, and drive operational improvements while supporting multiple departments and

Qualifications

• Bachelor's degree in Healthcare Administration, Public Health, Nursing, Business Administration, or related field preferred.
• Minimum of three (3) years of experience in provider relations, healthcare operations, managed care, practice management, quality improvement, population health, risk adjustment, or related field.

Responsibilities

• Serve as the primary point of contact for assigned provider practices and build strong relationships with physicians, office managers, practice administrators, and clinical staff.
• Conduct provider meetings and site visits to review performance, discuss initiatives, address challenges, and support improvement efforts.
• Support provider engagement, practice transformation, quality improvement, risk adjustment, utilization management, and value-based care initiatives.
• Educate providers and practice staff on HEDIS, CMS Star Ratings, risk adjustment, documentation requirements, population health, and quality improvement programs.
• Review provider performance reports and scorecards, identify improvement opportunities, and assist with development of action plans.
• Support providers in improving documentation accuracy, coding practices, care gap closure, chronic disease management, and patient outcomes.
• Assist with operational questions related to claims, referrals, authorizations, credentialing, provider data, and other provider service functions.
• Partner with Quality, Risk Adjustment, Care Management, Medical Management, Claims, Contracting, Credentialing, and Operations teams to support provider success.
• Monitor provider engagement activities, maintain accurate documentation, and provide updates on market and provider performance.
• Support implementation of new programs, payer initiatives, regulatory requirements, and organizational priorities.

Skills

Analytical skills

Relationship building

Communication

Organizational skills

Presentation & facilitation

Problem solving

Education

Bachelor's degree in Healthcare Administration or related field

Tools

Microsoft Office

Reporting tools

Job description

Astrana Health is seeking a Market Provider Relations Specialist in Houston to serve as the primary liaison between Astrana Health and provider practices. You will support provider engagement, transformation, quality improvement, risk adjustment, and value-based care initiatives.

Ideal candidates will build relationships with physicians and office staff, analyze performance data, educate on HEDIS and CMS Star Ratings, and drive operational improvements while supporting multiple departments and