Job ID: 293644
Provider Relations Specialist
Regular / Day
We Are Hiring
Provider Relations Specialist - Full-Time, Days - 523 Mainstream Dr - Nashville, TN
Why Join Ascension?
Ascension Care Management (ACM) creates customized healthcare solutions for health systems, payers, and employers that stabilize costs, improve outcomes, and enhance the experience for both providers and individuals. Our range of services strive to create a seamless healthcare experience for providers, payers and healthcare leaders by improving access to and removing complexity from the delivery of healthcare.
ACM serves 1.3 million patients across the nation and manages more than 20,000 providers through our clinically integrated networks of providers. ACM helps our customers eliminate stress and uncertainty, allowing them to confidently provide quality, value-based services and solutions. Beyond traditional population health management solutions, ACM offers additional expertise in claims management, care coordination, risk management and safety strategies that allow healthcare leaders to avoid challenges and capitalize on healthcare opportunities.
What You Will Do
As a Provider Relations Specialist will report to the Manager, Network Management. This role will manage all of the Compliance and Clinicial Integration requirements as setforth by CMS and our contract terms. The Provider Compliance Network Specialist’s activities will include, but are not limited to, developing and coordinating compliance and clinical integration requirements to our providers and set up our data system to track and record for each provider.
- Develops and manages the compliance activities on a calendar year to assure adherence and compliance requirements by all our populations.
- Leads provider campaigns around compliance, clinical integration, and quality metrics.
- Coordinates and manages the Shared Savings project plan for all populations
- Provider Network team lead for annual quality reporting requirements. Participates in regular meetings with vendors, providers, and quality team.
- Creates reporting for on-going percentage of compliance requirements by provider, TIN, and market.
- Responsible for managing CAQH including the reporting, invoices, and point person with the vendor.
- Coordinates with Marketing/Communication department to send surveys, presentations, videos, and through mylearning, for clinical integration and shared savings metric requirements. Includes managing the compliance rate and tracking in Salesforce.
- Develops in data elements in Salesforce based on new metrics identified.
- Carrying out physician engagement, communication and messaging activities as assigned
- Other duties as assigned.
What You Will Need
- Bachelor's Level Degree.
- Bachelor’s degree in business, healthcare or related field preferred.
- Master’s degree in Healthcare or Business Administration preferred.
- Five (5) years of experience is required to include the following: three years completing government provider enrollment applications for hospital and/or physician practice; two years in healthcare or insurance industry involving project management and process improvement.
- Three (3) years of provider relations, network management, or related healthcare experience preferred.
Equal Employment Opportunity
Ascension Health participates in the Electronic Employment Verification Program. Please click the E-Verify link below for more information.