The Affiliate Program Specialist will provide administrative, data analytics, and contracting support to the Affiliate Team. The Program Specialist will support the Director of Affiliate Operations and Contracting to ensure an appropriate network response to the service needs for Affiliate HMO and Commercial membership.
ESSENTIAL FUNCTIONS
- Responsible for quality and continuous improvement within the job scope.
- Responsible for all actions/responsibilities as described in company controlled documentation for this position.
- Contributes to and supports the corporation’s quality initiatives by planning, communicating and encouraging team and individual contributions toward the corporation’s quality improvement efforts.
- Prepare data and reports utilizing multiple data points and systems for Affiliate Leadership
- Manage Affiliate Database
- Administrative support to coordinate Affiliate facets, evaluate methods for improvement in process flows, help implement best practices for newly developed programs, and help maintain effective practices.
- Provide both administrative support and coordination to the Affiliate team, teammates, and clinician support teams.
- Prepare reports, analytics, and any other special reports/projects for management.
- Resourcefulness, ability to take the initiative when needed, and accountability for task completion.
- Track and summarize Affiliate projects and initiatives and assist the Affiliate team with identifying gaps and opportunities
- Facilitate communication to Affiliate offices and between HCP departments. Travel to Affiliate clinics to engage in face-to-face dialogue regarding various initiatives and operational updates
- Establish and maintain positive relationships with providers, their teammates, clients and Affiliate internal staff. Requires sensitivity to both Affiliates and health plans as well as strong persuasive skills.
- Plan, set up and support Affiliate Meetings in partnership with Quality, OCMO, CHAPs and other HCP departments.
- Obtains contract language, review comments and recommendations and serves as a communication contact for contract language changes.
- Coordinates involvement/approval of all contributing internal departments to structure design of contract.
- Resolves pay and/or provider problems throughout the contract negotiation process to ensure contract execution and implementation. Able to answer pertinent questions from provider.
- Identifies and investigates new contract opportunities. Collects due diligence background information on potential contracting parties.
- Monitors contracts, prioritizes workflow and initiates, and completes contract re-negotiations, renewals.
- Maintains excellent documentation of ongoing contract negotiation process including summaries of verbal discussion with internal and external parties.
- Provides sufficient and timely follow-up to payers’ to progressively move contract negotiations activity towards closure and execution.
- Maintains a strong understanding of health care/payer/provider industry and health care strategy of the health system, and utilizes knowledge on the job by reviewing literature relevant to the marketplace and managed care health needs, and industry pricing mechanisms, maintaining contracts with applicable payer organizations.
- Generate and distribute provider notice forms for new and existing providers and changes in provider system information.
- Assist in identifying trends in provider concerns and behaviors and develop plans for resolution.
- This person manages multiple priorities, meets deadlines, participates in group meetings, and uses departmental procedures and to create efficiencies and best practices.
- Assist with identifying utilization patterns which may negatively impact the network and provide corrective action plans.
- Performs additional duties as assigned.
- Performs other work related duties and responsibilities as directed, assigned or requested.
- Provides administrative support to Affiliate Program
- Collaboration and negotiation skills
- Research information, analyze data, exercise independent judgment, apply good organizational skills, and develop creative solutions to problems
EXPERIENCE REQUIREMENTS
- 3 plus years of professional experience post-high school in an office setting, customer service or other service industry.
- 2 years of experience in health related field preferred.
- Data management and experience
EDUCATIONAL REQUIREMENT S
- 1 to 3 years of post-high school education or a degree from a two year college
- Undergraduate degree in business or a health care related field preferred
KNOWLEDGE, SKILLS, ABILITIES
- Intermediate or Advanced Proficiency in Microsoft software applications: Outlook, Word, Excel, and PowerPoint.
- Detail-oriented; able to maintain integrity of data for multiple data-points in various systems
- Excellent track record of engaging customers or potential customers which can be applied to patient base. Marketing oriented skills that can be utilized to build clinic engagement.
- Strong program planning, organization, and interpersonal skills.
- Excellent written and verbal communication skills
- Self-starter with strong work ethic
- Valid Nevada driver’s license
WORKING CONDITIONS
- Working conditions are normal for an office environment
Physical Requirements:
Location:
White Drive Office
Work City:
Las Vegas
Work State:
Nevada
Scheduled Weekly Hours:
40
Source: Indeed.com
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