The Health Plan (THP) · 1 day ago
Practice Management Consultant
Wheeling, WV
Full-time
Onsite
Mid Level
3+ years expThe Health Plan (THP) is focused on enhancing provider experience and member satisfaction. The Practice Management Consultant is responsible for providing education and guidance to providers, performing on-site reviews, and driving quality discussions to improve care and satisfaction levels.
Health CareInsuranceNon ProfitWellness
Responsibilities
Held accountable for servicing providers within their territory and outside of territory, as assigned
Evaluate and monitor providers’ performance standards and financial performance of contracts as requested to support THP goals
Make regular visits, in-person, by phone and/or video call, to providers and act as primary resource for driving quality, operational efficiency and membership growth and retention
Travel throughout THP managed care service area, as required or assigned
Ability to cover a large geographic area
Outreach to contracted provider offices to educate as necessary
Knowledge of standard credentialing procedures
Communicate changes and updates to providers
Assist other departments with outreach to contracted provider offices as needed
Identify workflow processes and training to develop target initiatives to improve quality reporting
Facilitate contracted provider meetings
Familiar with all product lines, including education on billing services necessary to enhance company initiatives
Assist management in provider and quality reporting requirements
Regularly attend conferences and webinars to expand knowledge base
Train and offer technical assistance to providers for all THP applications
Work directly with clinical data and analytics team to track service trends and educate providers
Implement and coordinate programs to build and nurture relationships between THP, providers and office managers
Coordinate with Quality Improvement team to complete quality and department initiatives
Qualification
Required
College degree or 3-4 years' experience in a physician's office, payer agency, community agency or other health care environment
Valid driver's license
Previous customer service experience with exposure to claims and benefits interpretation and provider networking
Knowledge of medical coding
Knowledge of HEDIS® and Star Ratings
Computer experience with Microsoft Word, Excel, Power Point and Outlook
Preferred
Strong verbal and written communication skills with the ability to communicate (oral and written) effectively
Strong project management skills
Must be able to perform presentations for small and large audiences in person and remotely
Organizational skills with the ability to handle multiple tasks and/or projects at one time
Customer service skills with the ability to interact professionally and effectively with providers, and staff
Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time
Problem resolution skills
Ability to work under little supervision and act as a team member
Familiar with current managed care, State and/or Federal healthcare programs (Medicare, Medicaid) and the insurance industry
Experience in managed care, State and/or Federal health programs
Certified Medical Insurance Specialist (CMIS) and Certified Medical Coder (CMC)
Value based reimbursement/initiatives/projects experience
Company
The Health Plan (THP)
The Health Plan is a clinically-driven, technology-enhanced, and customer-focused health maintenance organization that manages and improves the health and well-being of its members.
501-1000 employees
H1B Sponsorship
The Health Plan (THP) has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2023 (1)
2022 (6)
2021 (7)
2020 (14)
Funding
Current Stage
Late StageLeadership Team
Ryan J. Ralston
Chief Financial Officer
Bob Roset
Senior Vice President, Information Systems (CIO)
Company data provided by crunchbase