Provider Engagement Manager

The Opportunity at Apixio:

Apixio's Risk Adjustment team is collaborating with health plans to assist them with their provider engagement efforts. The initiative aims to address and support value-based initiatives by working closely with provider networks to identify and address diagnosis gaps in advance.

Apixio is looking for applicants for the position of Provider Engagement Manager for our new Provider Engagement Team. This role is crucial as the successful candidate will be one of the founding team members responsible for building a new subdivision within Apixio. The role involves ongoing relationship management and essential provider support in contracted practices. Successful candidates will be instrumental in leveraging their relationships to onboard providers, encourage program participation, address provider queries on health plan risk adjustment and quality program tools, and support Point of Care (POC) integration. 

We will be asking of you:

Provider Onboarding

• Facilitate the onboarding process for new providers on health plan tools, applications, and alternative payment model programs. 
• Provide necessary technical and programmatic support and guidance during the onboarding phase.

Perform provider orientations and ongoing education, including writing and updating orientation materials.Training and Education

• Organize and lead regular meetings, in-services, forums, and other virtual events to foster collaboration and partnerships with external parties.
• Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefits Ratio (HBR), HEDIS/quality, cost, and utilization, etc
• Conduct regular training sessions to improve documentation and coding accuracy.
• Collaborate with stakeholders from Apixio, health plan, provider group medical coding teams, and training and medical directors, as needed.

Boosting Program Participation

• Build and maintain close relationships with providers with a hands-on approach to encourage active participation in health plan programs
• Identify and address any barriers to participation
• Analyze provider performance and utilization metrics to identify opportunities for improvement
• Drive incremental improvements in provider satisfaction and engagement scores under committed OKRs
• Conduct proactive outreach to practices/providers that are not meeting goals and provide support and guidance to achieve optimal program participation and performance
• Ensure that all provider engagement activities comply with relevant regulations and organizational policies 

Point Of Care (POC) Support:

• Become knowledgeable about the point-of-care connections in place at each provider location
• Support existing point-of-care workflows at each provider site location.
• Reduce administrative burden on practices through consistent support to providers and staff
• Provide feedback and insights on features, usage, and adoption to improve point-of-care solution capability

Handling Queries around Suspect and Provider Incentive Programs:

• Develop a thorough understanding of the insights delivered to provider workflows to help respond to queries and provide feedback to the health plan.
• Develop a comprehensive understanding of health plan provider incentive programs to handle inquiries and track progress toward goals effectively.
• Provide clear, concise, and accurate information to resolve inquiries or concerns promptly.
• Establish an escalation process for delivering feedback to the health plan provider relations and network resources.

Analytics and Reporting

• Develop and maintain comprehensive dashboards and reports to track provider performance, engagement metrics, and key performance indicators (KPIs).
• Analyze complex data sets to identify trends, insights, and opportunities for improving provider engagement and program effectiveness.
• Collaborate with cross-functional teams to define reporting requirements, ensuring data accuracy, relevance, and timely delivery.
• Utilize advanced analytical tools and methodologies to create actionable reports and visualizations that drive strategic decision-making.

What you bring to the table:

• Proven Experience: Minimum of 5 years in healthcare, provider engagement, or clinical settings.
• Technical Proficiency: Strong expertise in data analysis tools and software like SQL, Excel, Tableau, Power BI, or similar platforms.
• Analytical Skills: Exceptional ability to interpret and analyze complex clinical and provider data sets to drive insights and decision-making.
• Communication Skills: Excellent verbal and written communication skills, with the ability to present data and insights clearly to technical and non-technical stakeholders, including clinicians and healthcare providers.
• Provider Relationship Management: Demonstrated experience building and maintaining strong relationships with healthcare providers, focusing on improving engagement and performance. Prior experience in provider account management or contracting/networking within a health plan, provider, or other healthcare setting is required.
• Clinical Understanding: Solid understanding of clinical workflows, provider performance metrics, and healthcare operations to effectively analyze and report on relevant data. Experience with medical coding and provider documentation are essential components of clinical expertise.
• Program Management: Proven ability to manage multiple provider clients and programs simultaneously, with a strong track record of meeting deadlines and delivering high-quality work.
• Educational Background: Bachelor’s degree in healthcare administration, business analytics, or a related field. A master’s degree is preferred. 10 - 15  years of experience in relevant space without a degree.
• Health Care Acumen: Knowledge of Value Base Care, Alternative Payment Models, and frameworks designed to support innovative provider incentives to include Risk Adjustment for all lines of business (MA, Medicare, ACA, and Medicaid) and Quality (NCQA, HEDIS, STARS) practices 

Important Details:

• This position requires regular travel up to 50% of the time within the assigned territory and working within the provider's office if required. The ideal candidate will reside in New York, or Atlanta, Georgia. 
• This position requires someone comfortable with ambiguity and perseverance to build things from the ground up.

After 3 months, you will have accomplished: 

• In-depth familiarity with Prospective Risk Adjustment programs, products,  tools, and systems
• Drive program adoption and completion of critical success metrics with targeted provider groups 
• Support and help implement point-of-care programs to increase adoption and usage by up to 20 provider locations. This includes provider onboarding, boosting adoption, query handling, and providing feedback to help improve provider engagement and program compliance.