Provider Relations Specialist

1 week ago

Warrenville, United States NorthShore University HealthSystem Full time

Provider Relations Specialist

Under the supervision of the Vice President, Physician Engagement and Value-Based Care Performance, this position is responsible for the Endeavor Health Physician Partners (EHPP) provider relations/provider liaison activities, which include dissemination of information and education related to clinically integrated network (CIN) contracts, sharing of practice and provider level performance data, maximizing incentive revenues, provider issue resolution, and general liaison activities with network providers.

Position Highlights:

  • Position: Provider Relations Specialist

  • Location: Warrenville, IL

  • Full Time/Part Time: Full Time

  • Hours: Monday-Friday, during normal business hours

  • Required Travel: Occasional travel for off-site meetings

What you will do:

  • Serves as a primary interface to translate issues raised by EHPP network providers, subcontractors, and vendors to actionable matters for resolution, including but not limited to eligibility determinations, performance reporting, and medical pre-authorizations for EHPP members/patients. In this capacity also oversees the resolution of payor specific claim related issues by working with the providers and payor to identify the issue, engage relevant payor contacts, jointly identify a solution, and share resolution information with pertinent providers/stakeholders.

  • Works collaboratively with network providers to facilitate and coordinate success under the EHPP payor agreements through in-person, electronic, and telephonic interactions. Obtains provider level data, from various sources, to share with providers related to their performance under value-based agreements and support continuous improvement. Provides education and communication to physicians, managers, and staff regarding contractual obligations and operational components of value-based agreements and supports improvement actions as needed. Travels to and between various EHPP locations and offices as needed. Attends all appropriate physician events, including during off-hours.

  • Supports timely distribution of pertinent information to key stakeholders and network providers including payor policy and procedure updates, newsletters, reports, and CIN policy updates as necessary to maintain compliance with EHPP payor contracts and strong performance in VBC agreements.

  • Actively educates EHPP network providers and monitors compliance with the clinical integration (CI) technology infrastructure requirements for the CI program. In collaboration with subject matter experts, facilitates implementation of technology solutions within EHPP physician offices including granting and monitoring system access, determining curriculum content for training and educating on this curriculum, communicating key changes/updates, and tracking physician engagement related to use of the technology tool. Functions as a resource for questions related to basic CI technology questions.

  • Works with and guides practices in meeting requirements related to payor and/or regulatory programs required under the EEHP agreements. Specifically, assists with the dissemination, education, and communication of information related to EHPP payor agreements to both employed and independent EHPP providers.

  • Supports the CIN committee and governance structure as needed. Actively participates in committees and shares expertise including providing pertinent content and guidance. Participates in agenda creation, meeting facilitation and meeting follow-up as assigned.

  • Maintains knowledge of current trends and developments in value-based care including reimbursement methodology, reimbursement rates, and the impact on existing agreements. Demonstrates and understanding of priorities based on the organization's strategic plan/initiatives and stays current on all new organizational offerings and communications.

  • Assists with EHPP provider contracting and provider onboarding activities.

  • Maintains appropriate databases, interprets and analyzes physician statistical information and provides relevant progress reports including provider roster updates and monitoring for accuracy.

  • Supports incentive compensation distribution by tracking compliance with core requirements and confirmation of relevant legal and financial information needed to process payment.

What you will need:

  • Education: Bachelor's degree in health administration, public health, business administration or other related field. Master's degree preferred

  • Certification: n/a

  • Experience: Minimum 2 years of experience in managed care, value based care, clinical integration or provider relations. Experience working with physicians and practice managers in an ambulatory setting.

  • Unique or Preferred Skills:

    • Demonstrated strong leadership, communication, project management (formal or informal) and team building skills.

    • Excellent communication skills and the ability to present oneself and/or ideas with clarity.

    • Strong analytical, problem-solving and decision-making skills.

    • Excellent organizational skills and the ability to work at all levels of the organization.

Benefits (For full time or part time positions):

  • Career Pathways to Promote Professional Growth and Development

  • Various Medical, Dental, Pet and Vision options

  • Tuition Reimbursement

  • Free Parking

  • Wellness Program Savings Plan

  • Health Savings Account Options

  • Retirement Options with Company Match

  • Paid Time Off and Holiday Pay

  • Community Involvement Opportunities

Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.

When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.

Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best".

Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.

Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.

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