- Provider Education and Support: Deliver comprehensive education to providers, providing them with the necessary tools to meet Quality, Risk Adjustment, Growth (as applicable), and Total Medicare Cost goals outlined in business development plans.
- Accountability and Performance: Understand the financial performance and overall profitability of each practice and assume accountability for overall performance, and profitability within assigned provider groups, program incentives, and best practices in patient care. Ensure providers possess a thorough comprehension of contractual obligations. Responsible for communicating and reviewing ongoing performance against Key Performance Indicators, such as HCC recapture rate, Stars performance, MLR, and other crucial clinical outcomes, with actionable steps for improvement.
- Provider Training and Orientation: Conduct comprehensive new provider orientations and ongoing educational sessions for providers and their staff, covering healthcare delivery products, health plan partnerships, processes, and patient care plans.
- Provider Retention: Responsible for ensuring that the organization is meeting provider retention goals, and minimizing provider attrition, which are primarily driven by provider satisfaction.
- Provider Collaboration: Facilitate regular provider meetings to disseminate economic data, troubleshoot issues aimed at enhancing patient outcomes and operational efficiencies. Coordinate and facilitate Joint Operational Committee meetings where applicable, to align strategies and goals.
- Performance Improvement Plans: Responsible for developing, implementing, and monitoring performance improvement plans for assigned groups. Will report progress against these plans to internal stakeholders, including leadership, with specific metrics and benchmarks for evaluation.
- Provider Negotiations: Negotiate proposed modifications to existing contact terms and work with leadership. Finance and Network Committee to analyze such proposals and make informed decisions.
- Communication and Issue Resolution: Maintain open channels of communication with providers, facilitating timely resolution of health plan issues related to claims, eligibility, utilization management, quality, and risk adjustment programs and include a mechanism for feedback from providers to improve communication effectiveness.
- Strategic Planning: Integrate strategic interventions via cross-departmental collaboration to enhance overall effectiveness and performance, such as implementing new care coordination models or quality improvement initiatives.
- Onsite Provider Visits: Must spend a minimum of 80% of his/her workweek visiting Providers onsite at their Practice, in line with Genuine Health's high-touch model, with clearly defined objectives and outcomes for each visit. All activity must be logged into CRM.
- Engagement with Specialists: Where appropriate, focus on engaging specialists and ancillary providers who demonstrate high quality ("high performing"), and implementing best practices and communication channels between select Providers located within a reasonable distance and those deemed "high performing" specialists and/or ancillary Providers, to improve coordination of care and outcomes.
- Exceptional interpersonal skills with ability to interface effectively both internally and externally with a wide range of people including physicians, office staff, hospital executives and other health plan staff
- Demonstrated experience with making presentations to both small and large groups
- Excellent communication skills (written and verbal) and ability to communicate effectively with external and internal audience at all levels
- Ability to gather and analyze information and communicate to others
- Analytical, problem-solving, and troubleshooting skills
- Time management and organizational skills
- Ability to work well with others and work in a team environment
- Pays close attention to detail, is resourceful and highly dependable
- 5 years of experience in a healthcare-related position, preferably managed care environment and/or Bachelors' Degree in a health-related field or Business Administration or equivalent combined experience
- 3+ years' experience in Provider Relations, Network Management, Contracting, Credentialing
- Must have a valid Driver's license, clean driving record, and reliable transportation.
- Travel up to 60% within Miami-Dade and Broward counties.
- Proficient in MS Office programs (i.e., Word, Excel, Outlook, Access, and Power Point). Moderate to advanced in excel.
- Prior experience and/or knowledge of HEDIS, CMS Star Rating System, and/or Medicare Risk Adjustment is preferred.
- Prior experience and/or knowledge of CMS and Medicare Advantage payment methodologies, and Value-Based Contracting is preferred.
- Bilingual: Spanish and English.
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Physician Performance Representative - Miami, United States - Genuine Health Group LLC
Description
Summary:The Physician Performance Representative plays a crucial role in cultivating, nurturing, and enhancing a robust and satisfied provider network within an assigned geographical area. Designated as the primary liaison between Practice, Genuine, and Health Plan Partners/CMS. The primary focus lies in collaborating closely with assigned providers to enhance overall performance across key performance indicators, including cost reduction, revenue optimization, quality enhancement, & provider satisfaction.
Essential Duties and Responsibilities:
Genuine Health Group is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Physician Performance Representative professionals in Miami
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Sarah Nassar
Physician Assistant, MMS
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sebastian sierra
Registered Nurse
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Edward Vergara
Tech-savvy salesman
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Lexi Mazzucchelli
Executive Personal Assistant
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Carlos Gonzalez
Aviation Expert