Provider Engagement Specialist

🕒 June 9

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $54.4k - $81.7k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

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Alignment Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

👥 B2C

💰 $321.1M Post-IPO Debt - Alignment Health on 2024-11

Healthcare Insurance • B2C

Alignment Health is a Medicare-focused health insurance company that offers Medicare Advantage plans and member-centered services. It provides 24/7 on-demand access to care via in-person, in-home, and mobile channels and features a concierge-style on-demand card to help members schedule appointments, arrange transportation, and answer health questions. Alignment Health partners with brokers, providers, Accountable Care Organizations (ACOs), and institutional partners, operates in multiple U. S. states (including Arizona, California, Nevada, North Carolina, and Texas), and has earned high CMS ratings and industry recognition.

📋 Description

• Build and maintain collaborative relationships with providers, office staff, and key stakeholders to support network growth and performance • Conduct provider onboarding, orientations, and ongoing education initiatives • Perform regular in-person provider visits to review performance metrics and identify improvement opportunities • Analyze provider performance data and deliver actionable insights to optimize outcomes • Educate providers on HEDIS, Stars, Risk Adjustment, and documentation/coding requirements • Develop and implement provider engagement strategies to improve quality scores and member experience • Support resolution of provider issues related to access, claims, eligibility, and utilization management • Create and deliver training materials, in-service presentations, and Model of Care trainings • Maintain accurate provider data and activity tracking in Salesforce and internal systems • Support provider recruitment, contracting, and credentialing processes • Negotiate and implement provider agreements in assigned markets • Track recruitment and contracting activity and provide regular reporting • Serve as a primary point of contact for provider inquiries, ensuring timely resolution • Participate in team meetings and contribute to special projects as needed • Exercise independent judgment and decision-making on complex issues with minimal supervision

🎯 Requirements

• Minimum 1 year of experience in provider relations, contracting, or network management within an HMO, IPA, medical group, or healthcare organization • 2+ years of provider-facing experience, including Medicare lines of business (preferred) • Strong understanding of HEDIS, Stars, Risk Adjustment, and MLR • High School Diploma or GED (Bachelor’s degree or equivalent experience preferred) • MBA (preferred) • Proficiency in Microsoft Office (Word, Excel, PowerPoint)

🏖️ Benefits

• Health insurance • 401(k) matching • Flexible work arrangements • Paid time off • Professional development opportunities