Job description
LE0006 MSO of Puerto Rico, LLC
It's fun to work in a company where people truly BELIEVE in what they're doing!
We're committed to bringing passion and customer focus to the business.
POSITION DESCRIPTION
Serves as the field liaison between the contracted providers and the MSO which will organize and optimize interventions to achieve desired results based on thorough analysis of the Provider’s performance.
RESPONSIBILITIES
- Acts as primary liaison to Provider as assigned within the region. Provides initial and ongoing negotiation regarding providers contracts according to MSO policies and procedures.
- Translates strategies into interventions with providers. Develops and prioritizes monthly Provider visits and ensures interventions are executed in a timely manner.
- Communicates and tracks corrective actions plans as needed to Providers and ensure Providers compliance while assisting with resolutions.
- Coordinates and Collaborates in the implementation of educational activities geared at improving compliance with policies and procedures of the MSO and utilizing MSO University.
- Educates providers regarding preventive care and quality measures as establish by the MSO.
- Interface with the Providers leadership to ensure member and provider satisfaction and network integrity.
- PPE and PPE CAP Management meetings as assigned.
- Works collaboratively with internal business units to validate coding errors by providers and establishes communication plans to ensure such errors are corrected, with minimal impact to providers, members and MSO.
- Implements and maintains provider contracts and communication (i.e., manuals, reference materials, newsletters, bulletins, etc.)
- Identify physicians requiring interventions based on performance.
- Accountable for issue escalation from providers
- Update provider contract to comply with CMS regulations and Plan policies and procedures as directed.
- Coordinates / advocates resolution of provider issues and concerns.
- Inter-departmental resource for all provider / network issues, problems or concerns.
- Convene providers for special meetings and activities, as required.
- Represent the company in special activities related to provider relations.
- Assists with special projects as assigned.
- Assists in Provider presentations that will enable providers to increase their performance in accordance with MSO objectives.
- Communicates and monitors proposed strategies to improve quality and health outcomes to Providers and agreed upon course of actions.
- Analyze performance based on the MSO objectives, identify opportunities and collaborate to design and implement customized strategies with the Providers.
- Assist the Regional Director in overseeing and ensuring compliance with quality and compliance of all services provided by the MSO in support of the Provider.
- Support Regional Director in ensuring compliance with Provider’s annual financial and operational performance objectives.
- Must maintain total confidentiality with all handling of data and information.
BUSINESS SKILLS
Fully understands the MSO Operations
Knowledge of Provider reimbursement and Provider/Group staff models
General knowledge of Marketing Guidelines
General knowledge of Quality Measures
Focus on provider’s relations development
Excellent knowledge of competitive environment and market intelligence
Ability to set strategy and implement interventions that support the organization’s overarching goals
Understand Company strategies for cost containment and quality metrics in inpatient, outpatient and pharmacy
General knowledge of Physicians, Hospitals and Ancillary provider’s compensation models
General knowledge of internal operational processes for payment processing and claims recovery process.
EDUCATION AND EXPERIENCE
Minimum Requirements:
- Bachelor's degree (B. A.) from four-year College or university. One to two years related experience and/or training; or equivalent combination of education and experience.
- Good Financial background, that should include financial reconciliation, cost analysis, budgeting and forecasts.
- Good Communications skills
- Previous team leadership experience and proven results.
LANGUAGE SKILLS
- Excellent oral and written communication skills for both internal and external communications in both English and Spanish.
- Broad based background in health care and medical management essential.
- Ability to read, analyze, and interpret general business periodicals, operating and maintenance instructions, procedure manuals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!
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