Provider Engagement Specialist — Field-Remote

Alignment Health; United States; Remote; USD 54,000 - 82,000; Full time

Job summary

Alignment Health is seeking a proactive Provider Engagement Specialist to join the Provider Engagement team supporting the San Antonio market.

In this field-remote role, you will build trusted relationships with physician practices and provider groups, partnering with them to improve performance across quality, growth, retention, and utilization metrics while supporting Alignment Health’s continued network expansion.

Qualifications

• 2 years related experience and/or training; or equivalent combination of education and experience.
• Experience in provider relations / contracting with an HMO or IPA, medical group or institutional provider required

Responsibilities

• Build and maintain collaborative relationships with providers and staff to support growth, retention, and performance improvement.
• Partner with providers to improve performance on KPIs including growth, retention, AWVs, HEDIS gap closures, hospital and ER utilization, risk adjustment and other quality indicators.
• Conduct provider onboarding and provide ongoing education on Alignment tools, clinical programs, PCP incentives, Member benefit offerings, Model of Care and other compliance requirements.
• Assist in developing training materials/tools; create provider in-service and implementation packets.
• Facilitate and serve as a single point of resolution for provider issues including UM, prior authorization, claims, encounter data, eligibility, provider rosters and directory validation.
• Represent Alignment Health at provider meetings, trainings, and community events; document minutes and action items.
• Maintain department databases and tracking tools to document and monitor provider engagement activities and outcomes.
• Negotiate and implement standard physician and ancillary agreements; obtain provider credentialing; track recruitment activity.
• Maintain weekly activity summaries and submit reports on a weekly basis.
• Attend and participate in all staff meetings; perform special projects as assigned.

Skills

Relationship building

Organization

Communication

Bilingual English/Spanish

Education

BA/BS or equivalent

Tools

MS Office (Word, Excel, PowerPoint)

Job description

Alignment Health is seeking a proactive Provider Engagement Specialist to join the Provider Engagement team supporting the San Antonio market.

In this field-remote role, you will build trusted relationships with physician practices and provider groups, partnering with them to improve performance across quality, growth, retention, and utilization metrics while supporting Alignment Health’s continued network expansion.