Provider Engagement Specialist – Medicare Advantage | Wake County, NC

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. 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 Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Provider Engagement Specialist is responsible for developing and maintaining strong relationships with provider offices to improve network performance, enhance provider satisfaction, and support organizational growth. This role partners with providers on strategies to increase patient retention and growth, while also driving performance across key quality and utilization metrics. The Provider Engagement Specialist serves as the main point of contact for providers, offering education, support, and tools to achieve goals.

General Duties/Responsibilities (May include but are not limited to):

• Build and maintain collaborative relationships with providers and their staff to support growth, retention, and performance improvement.

• Partner with providers to improve performance on key performance indicators (KPIs), including but not limited to growth, retention, Annual Wellness Visits (AWVs), HEDIS gap closures, hospital and ER utilization, risk adjustment and other quality indicators.

• Conduct initial provider onboarding and provide support for ongoing provider education on Alignment tools, clinical programs, PCP incentives, Member benefit offerings, Model of Care and other compliance requirements, and Alignment initiatives.

• Assist in the development of training and educational materials/tools. Create provider

in-service and implementation packets.

• Facilitate and serve as a single point of resolution for provider issues, including but not limited to UM, prior authorization, claims, encounter data, eligibility, provider rosters and directory validation.

• Represent Alignment Health at provider meetings, trainings, and community events. Document meeting minutes and action items as needed.

• Consistently utilize, update and maintain department databases and tracking tools to ensure provider engagement activities, provider visits and outcomes are documented and monitored.

• Negotiate and implement standard physician and ancillary agreements; obtain provider credentialing; utilize network database to track recruitment activity.

• Maintain weekly summary of activity and submit reports on a weekly basis.

• Attend and participate in all staff meetings as required.

• Perform special projects as assigned.

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.

Minimum Experience:

Two 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

Education/Licensure:

B.A./B.S. OR 2 years relevant experience

Other:

• Bi-lingual preferred

• Organized, detail driven and a self-starter.

• Strong analytic, quantitative, and problem-solving skills.

• Strong verbal and written communication skills.

• Relationship-builder and team-player

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

• Computer Skills: Proficient user in MS office suite (Word, Excel and PowerPoint). 80% or more travel by car routinely required (In assigned market). Travel by plane required as needed. Maintenance of reliable means of transportation and valid driver’s license and automobile insurance required.

• Extended works hours, as needed. Remote work on approval.

Work Environment:

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.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and…