The Provider Management Communications Consultant is responsible for the development and implementation of provider and member communications that increase the effectiveness of providers’ compliance and understanding of System of Care policies and procedures, and members’ understanding of eligibility criteria. The incumbent is responsible for all communication tasks that impact either internal or external customers. This work includes but is not limited to: Youth and Family Guide, website additions and revisions, provider email notifications, member change notices, new hire notices, State policy notifications, State notifications of staffing changes, provider presentations, annual Communication Plan and Frequently Asked Questions (FAQs). The Provider Management Communications Consultant will be an active member of the Parent Leaders for PerformCare stakeholder group. The Specialist will prepare Executive Director communications and cross all Departments. In addition, the Specialist will take a lead role in researching and communicating trends in service and outcomes of care.
- Assists with the development and implementation of Provider communications that meet the overall strategy and priorities of AmeriHealth Mercy Family of Companies and the Plan’s Annual Operating Goals (AOP).
- Prepares and distributes quarterly (or ad hoc as requested) reports of educational activities for the Executive Director which are shared with appropriate PLAN management for distribution to the State, AMFC, and PerformCare corporate office.
- Assists with strategies to engage providers in best practice activities.
- Assists in preparation of educational tools for Account Executives use in educating contracted and non-contracted providers. This includes items such as professional services billing, electronic claims transactions, electronic fund transfers, etc.
- Responsible for assessing competitor information and implementing recommendations.
- In conjunction with the Executive Director and Department Heads, assists with development of PLAN resources such as provider manual, Plan E-Business Technology, web site development and maintenance, and fee schedules, etc.
- Interfaces with Plan’s data analyst to compile, analyze, and disseminate information from provider calls, reports, and trends.
- Assists Executive Director with identifying trends and implements the plan to improve provider satisfaction and compliance with Plan operations, payment policies, prior authorization requirements, etc.
- Develops provider education materials for activities related to development/distribution of provider manuals, materials and provider forms with Executive Director’s approval consistent with Enterprise processes.
- Collaborates with clinical team regarding implementation of products and communications related to improved health/behavioral health status of our members, achieving NCQA accreditation, HEDIS measures, etc.
- Maintains positive relationships with the provider community.
- Participates as a member of the corporate provider communications team.
Key Competencies/Success Factors:
- Performs other related duties as assigned.
- Supports and carries out the Mercy Mission and Values.
- Attends required training on an annual basis.
- Ability to turn data into information, manage work processes, develop communications materials, conduct focused examination of conditions requiring correction, and develop a precise definition of the problem.
- Strong written communication and presentation skills
- Building long term relationships
- Ensuring project discipline
- Demonstrating service discipline
- Working across boundaries
- Ability to appropriately and effectively address diverse audiences.
- Proficient with office software applications (e.g., Microsoft Office Suite of products)
Education and Training:
- Bachelor Degree in Communications, English, or Marketing or equivalent combination of education and work experience in a Behavioral/Health Care Field preferred.
Licenses, Registrations or Certifications:
- Minimum 1 – 2 years’ experience in member and/or provider operations in a behavioral/ healthcare or Managed Care Organization
- 1-2 years customer service experience preferred
- Experience in training and communication material development
- 1-2 years Medicaid experience preferred
AmeriHealth Caritas - 21 months ago