Job Overview:
The Provider Relations Specialist (PRS) will be responsible for managing and maintaining relationships with assigned healthcare provider accounts. The PRS will facilitate communication between the providers and Salud, ensuring that providers understand and comply with risk adjustment data, HEDIS measures, and utilization expectations. The role involves educating provider offices, conducting regular check-ins, and offering support for the completion of necessary tasks.
Key Responsibilities:
- Schedule Visits: Plan and conduct 4-5 visits daily with assigned provider accounts.
- Risk Adjustment Data Review: Review and discuss Risk Adjustment data provided by Salud with the provider offices, ensuring they understand the expectations.
- HEDIS Measure Review: Perform HEDIS measure reviews to identify open measures, provide education on current gaps, and ensure timely resolution.
- Utilization Discussion: Meet with providers quarterly to review utilization data and discuss opportunities for improvement.
- Monthly Follow-Up: Ensure that all identified issues and necessary actions from prior visits are followed up on and completed by the providers within the designated timeframes.
- Check List Review: Ensure the provider offices have a clear understanding of requirements and expectations by reviewing checklists and offering support for compliance.
- Documentation: Maintain accurate records of all visits, discussions, and follow-up actions for each assigned account.
- Support & Education: Offer ongoing support and education to provider offices as needed, addressing any questions or concerns regarding Risk Adjustment, HEDIS, or utilization.
- Relationship Management: Develop and sustain positive relationships with healthcare providers to ensure successful collaboration and outcomes.