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

💰 $135M Series C on 2020-03

Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

📋 Description

• Support the performance and growth objectives of the assigned market by building relationships with primary care and specialist providers • 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 • Participate in team meetings and contribute to special projects as needed

🎯 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) • Valid driver’s license required • Reliable transportation and current automobile insurance required

🏖️ Benefits

• Health insurance • 401(k) matching • Flexible work hours • Paid time off • Remote work available with approval