Provider Engagement Specialist

1 month ago

Farmington Hills, United States Commonwealth Care Alliance Full time

Position Summary:

The Provider Engagement Specialist ACO/PO works closely with participant providers within the organization's ACO and/or Physician's Organization. The Provider Engagement Specialist will conduct reviews and audits for designated quality metric compliance via onsite and EMR review and work with providers to nominate or maintain Patient Centered Medical Home designation (if applicable). This position partners with providers to support in office improvement efforts and education aimed at increasing the rate of preventive and annual screens delivered to beneficiaries to meet established target performance to achieve quality bonus status for the Accountable Care and Physician Organization.

Supervision Exercised:

  • No, this position does not have direct reports.


Required Education (must have):

  • High School Diploma

Desired Education (nice to have):

  • Associate degree

Required Experience (must have):

  • Experience with medical terminology acquired through two years' work experience or education.
  • Previous quality experience

Desired Experience (nice to have):

  • Patient Centered Medical Home experience

Required Knowledge, Skills & Abilities (must have):

  • Attention to detail, analytical skills, ability to work independently, time management.
  • Excellent verbal, written and presentation skills.
  • Outstanding Customer Service Skills.
  • Intermediate Microsoft Office competency, including Outlook, Word, Excel & Power Point.
  • Ability to multi-task.
  • Ability to interact well with individuals on all levels and maintain a professional image and attitude.

Required Language (must have):

  • English


  • Be the conduit to provider practices in Michigan; develop provider educational materials and trainings to increase effectiveness to close clinical gaps in their patient care; use data and reporting to deliver feedback, identify areas of need and communicate to practices opportunities for improvement, and maintain/attain PCMH (if applicable).
  • Provide in-office support of select practices to support improvement activities. This includes, but is not limited to, providing education on improvement tools to assist with practice adoption, and support in office practice education creation of workflow to improve metrics, and maintain/attain PCMH (if applicable).
  • Contact and work with doctor's office on notification, scheduling, and logistics for completing the review.
  • Conduct on-site review and document all quality information from the files reviewed.
  • Review reports for audit scope. Research and analyze reports to narrow and define scope for on-site review and review period.
  • Work with physician's office staff in obtaining information for completion of reviews and audits, and maintain/attain PCMH (if applicable).
  • Prepare review audit findings and reports identifying areas of non-compliance and risk areas for non-compliance.
  • Manage risk areas for non-compliance with office contacts and provide education, create roadmap to improving compliance with physician, or office staff to reduce risk identified.
  • Build relationships with physician's office staff for future activity. Escalate office or relationship issues to CCA ACO/PO Michigan leadership.
  • Collaborate internally to obtain, share and suggest information for advancing the mission of the organization.
  • Conduct EMR/record searches for audit measures with multiple year look back periods to improve chart capture rates (for instance: colorectal cancer screenings and mammograms)
  • Develop strong professional relationships with all providers and their staff while functioning as a liaison to the provider community.
  • Establish regular contact with and visits to provider sites. Visits may include regular operations meetings, staff education, provider orientations, and appreciation events.
  • Physician Organization PCMH Offices (if applicable):
  • Facilitate ongoing recruitment, implementation, and maintenance of PCMH capabilities and initiatives required for nomination and designation.
  • Support the development and preparation of program resources.
  • Provide office support and training in PCMH practices.
  • Educate practices how PCMH capabilities lead to improved quality, utilization, and cost performance.
  • Other duties as assigned.

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