Medicare Star Provider Relations Specialist

Alignment Healthcare is a consumer-centric platform delivering customized health care in the United States to seniors and those who need it most, the chronically ill and frail, through its Medicare Advantage plans. Alignment Healthcare provides partners and patients with customized care and service where they need it and when they need it, including clinical coordination, risk management and technology facilitation. Alignment Healthcare offers health plan options through Alignment Health Plan, and also partners with select health plans to help deliver better benefits at lower costs.

By becoming a part of the Alignment Healthcare team, you will provide Medicare enrolled consumers the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

Position Summary:

The Medicare Star Provider Relations Specialist (MSPRS) is responsible for providing Medicare Star/HEDIS support and training for direct providers and contracted provider groups. This position serves as a liaison between Alignment Health plan and IPA/MSO partners. The MSPRS will function as the single point-of-contact for all on-going Medicare Star, HEDIS, and CAHPS issues as needed by providers and is responsible for timely and professional interaction with internal and external customers.

General Duties/Responsibilities (May include but are not limited to):

1.       Facilitate IPA and MSO education and training in order to increase their familiarity and satisfaction with Alignment’s systems and strategies, including training and education on Star including: HEDIS, HEDIS data submission, CAHPS and clinical initiatives.

2.       Facilitate provider and office staff education and training to increase their familiarity and satisfaction with Alignment’s systems and strategies, including training and education on CAHPS, HEDIS, and HOS as well as Star and clinical initiatives.

3.       Set targets and priorities to meet national HEDIS/Star and market-specific Medicare Star Program needs.  Research issues related to measures not meeting benchmark and drive internal resolution. 

4.       Connects meaningfully internal departments to build emotional engagement and customer advocacy. Simplifies complexity and integrates internal efforts to deliver an optimal HEDIS/Star performance organizationally. 

5.       Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints. 

6.       Engages others by gathering multiple views and being open to diverse perspectives. 

7.       Assess IPA and MSO performance and provide actionable items to increase performance in underperforming areas.

8.       Maintain and build meaningful relationships with IPA and MSO partners to facilitate cooperation and collaboration.

9.       Implement performance related campaigns throughout the year that target specific areas of STAR performance.

10.   Serves as primary point of contact for IPA and MSO data exchange communication and manages quick resolutions to ensure quality of internal data.

11.   Research any supplemental data exchange issues and correct them in a timely manner with IPA/MSO.

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.       Minimum Experience:

a.       2+ years of HEDIS and Medicare Star program

b.       4+ years HEDIS and Medicare Star program experience, preferred

2.       Education/Licensure:

a.       Bachelor’s degree

3.       Other:

a.       Experience reconciling data discrepancies, and encounter submission errors between provider and healthcare plan

b.       Working knowledge of healthcare provider business operations

c.       Knowledge of healthcare, managed care, Medicare

d.       Strong communications skills: written, verbal, and interpersonal

e.       Intermediate to Advanced computer skills

f.        Working Conditions (TBD due to COVID):

               i.      Office Hours: Monday-Friday, 8am to 5pm. Extended work hours, as needed.

               ii.      Up to 60% of travel by car routinely required.

               iii.      Travel by plane required as needed to support provider services needs in other geographies.

               iv.      Maintain reliable means of transportation. If driving, must have a valid driver’s license and automobile insurance.

4.       Work Environment:

1. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact [email protected].