Provider Engagement Consultant Resume Sample
Cielo Hegmann
1042 Kertzmann Lock,
Detroit,
MI
+1 (555) 616 2868
Work Experience
Senior Products Provider Engagement Consultant
03/2017
-
PRESENT
Boston, MA
- Help identify and pursue potential providers who could become an asset to promote the health plan’s overall health care initiatives and quality of service
- Communicate members’ and providers' needs to internal stakeholders in order to drive creation of solutions that meet our mutual business goals
- Respond to providers’ requests by directing them to appropriate internal or external resources
- Support member retention events/activities and health plan communal initiatives (e.g. Alzheimer’s Walks, Special Olympics, Ride 2 Recovery, etc.)
- Execute plan marketing strategies to increase market share in DSNP TX Markets
- Demonstrate understanding of all Texas Medicaid & Medicare lines of business as they apply to managed care and the needs of the members enrolled in them in order to facilitate their care and resolution of their issues
- Maintain strong business relationships to ensure retention of existing contracted providers therefore decreasing loss in membership due to provider terminations
- Advocate the use of Provider Tools, online technology and health plan resources, (e.g. LINK, , Provider Manuals)
- Analyze data to determine root cause of issue (e.g., identify trends and patterns; identify outliers and anomalies) and/or escalate problem to appropriate business partner for further analysis, as necessary
Provider Engagement Consultant
04/2010
-
02/2017
Chicago, IL
- Involve leadership and/or escalate issues as necessary to implement provider / member solutions
- Solicit provider informal and formal feedback via surveys, complaints and conversations in order to develop action plans (e.g., corrective actions; suggestions to leadership; complaint resolution processes, etc.)
- Support member retention events/activities and health plan communal initiatives (e.g. Member advisory council meetings, Alzheimer’s Walks, Special Olympics, Ride 2 Recovery, etc.)
- Market based point of contact for Health Plan and ACO participating providers
- Develop and maintain collaborative provider relationships that facilitate provider engagement, integration, and path to value arrangements
- Partner with the provider community to develop capability for sustained, integrated consumer interaction programs building consumer advocacy and loyalty
- Manage provider engagement/risk continuum, prospecting potential providers for value based opportunities
- Apply network configuration and incentive - based payment models as appropriate to improve quality and efficiency
Education
Strayer University - Delaware County Campus
2006 - 2010
Bachelor's Degree in Business
Professional Skills
- Strong relationship building skills & customer service driven
- Strong relationship building skills with both internal and external partners
- Proven analytical skills with the ability to communicate financials
- Prior experience in healthcare and/or managed care
- Strong organizational, interpersonal, communication, and presentation skill
- Sales or contracting experience within a managed care environment
- Experience thriving in a matrix environment
How to write Provider Engagement Consultant Resume
Provider Engagement Consultant role is responsible for modeling, database, analytical, power, travel, insurance, design, integration, finance, building.
To write great resume for provider engagement consultant job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Provider Engagement Consultant Resume
The section contact information is important in your provider engagement consultant resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Provider Engagement Consultant Resume
The section work experience is an essential part of your provider engagement consultant resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous provider engagement consultant responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular provider engagement consultant position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Provider Engagement Consultant resume experience can include:
- Leverage financial and utilization data with physicians and healthcare executives to provide actionable goals and opportunities to reduce expenses for providers with a shared savings opportunity
- Experience in a fast paced insurance or health care setting
- Partner with internal stakeholders to create a seamless experience for providers
- Assists Network Management with organizational effectiveness to drive improved performance outcomes
- Coordinates and facilitates cross functional meetings to drive process improvements and organizational effectiveness for value added outcomes
- Four or more years’ of provider related work experience such as education, reimbursement, administrative medical policy, complex issue management
Education on a Provider Engagement Consultant Resume
Make sure to make education a priority on your provider engagement consultant resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your provider engagement consultant experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Provider Engagement Consultant Resume
When listing skills on your provider engagement consultant resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical provider engagement consultant skills:
- Strong facilitation skills with an ability to run provider meetings with prioritized specific topic agenda reflecting entire provider support
- Computer literate (MS Word, Power Point, Excel). Proven analytical skills, spreadsheet modeling
- Proficient in MS Word, Power Point, & Excel. Proven analytical skills, spreadsheet modeling and database development
- Prior experience working in a provider facing role
- Prior experience in working with quality metrics in a fast paced insurance or health care setting
- Prior experience working with Medicare and/or commercial products is highly desirable
List of Typical Skills For a Provider Engagement Consultant Resume
1
Skills For Senior Products Provider Engagement Consultant Resume
- Prior experience working with or for a medical practice, IPA or MSO
- Healthcare, Managed Care and Marketing experience
- Managed Care and Marketing experience
- Valid driver’s license and proof of personal vehicle liability insurance with at least 100/300/100 limits
- Partner with all internal stakeholders and leverage the experience from all
- Professional certification in healthcare related area and/or direct Medicare managed care experience
- Experience with prominent provider groups
- Claims and/or referral background experience
- Quality HEDIS GAP closure experience
2
Skills For Provider Engagement Consultant Resume
- Physician liaison experience
- Working knowledge of Medicare products
- Working knowledge of Medicare and Medicare Advantage
- Understanding of Medicare Insurance
- Understanding of STARS and/or HEDIS measures
- This is a provider facing role requiring day travel
- Three or more years in a contracting or provider servicing or relations role
- Knowledge of PC and standard office software, including Word, Excel and PowerPoint.MS Office applications
- Travel 40-50% of the time during the day
3
Skills For Senior Products Provider Engagement Consultant Resume
- Knowledge of Provider Contracts and contracting processes
- Analyze data, identify root causes/process improvement opportunities and propose solutions
- Handle multiple tasks and deadlines with attention to detailThis role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100/300/100 limits
- Handle multiple tasks and deadlines with attention to detail. This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance with at least 100/300/100 limits
- Prior experience in provider relations in a fast paced insurance or health care setting
- Working knowledge of HEDIS
- Understanding of STARS/HEDIS metrics
- This role is part of Humana’s Driver safety program and therefore requires an individual to have a valid state driver’s license and proof of personal vehicle liability insurance
- Knowlede of HEDIS required
4
Skills For Provider Engagement Consultant Resume
- Intermediate level of proficiency with SharePoint, Windows PC applications and Microsoft Office (Word, Excel, Outlook, and PowerPoint)
- Travel within assigned territory (Service Delivery Area) and to other markets as needed
- Experience with SharePoint (data entry, documentation, and reporting), Windows PC applications and Microsoft Office (Word -create & edit documents, Excel – sort & filter data, Outlook – emailing & calendar, and PowerPoint – create presentations from scratch)
- Manage provider continuum, prospecting the provider’s readiness for enhanced value based opportunities
- Design and execute profitable growth strategies to align with the Provider Engagement Director’s market strategy and the provider’s needs
- Work in a consultative role with various departments locally and at corporate headquarters in creating effective information and analyses in order to optimize the market’s strategic objectives
- Create strategic provider partnerships with path to value providers to improve their experience with Humana. Be a strong partner and build relationships with internal stakeholders to create a seamless experience for the provider
- Experience working in a provider facing role
- Experience with ACO, Risk-Based, Value-Based Contracting highly desirable
5
Skills For Senior Products Provider Engagement Consultant Resume
- Knowledge of Florida Blue claims adjudication processes and claim processing systems
- Execute profitable growth strategies
- Work closely with Humana MarketPoint leaders and staff to support profitable growth strategies to align with the Provider Engagement Director’s market strategy and the provider’s needs
- Develop and/or implement processes and data sharing structure for assigned providers –
- Develop and review Dashboard Metrics (quality, financial, clinical) and translate into actionable items based on group specifics
- Familiarity with HEDIS measures and gap closure
6
Skills For Provider Engagement Consultant Resume
- Travel within the region up to 60% of the time with the possibility of overnight travel
- Travel throughout the region up to 75% of the time
- Advanced knowledge of HEDIS measures
- Knowledge of technological trends and internal Florida Blue systems, JIVA, Diamond, Siebel etc
- Knowledge of non-claims issues such as remittance advice, eligibility, benefits, authorizations and referrals
- Knowledge of Availity Self-Service tools and HIPPA required transactions
- Knowledge of HIPPA requirements, policies and processes
7
Skills For Senior Products Provider Engagement Consultant Resume
- Proficient in MS Word, Power Point & Excel
- · Work to develop and improve EMR capability
- Support resolution and prevention of escalated provider issues with assigned regional markets and Medical Directors
- Directs and manages projects and/or initiatives. Ensure integration across projects to ensure alignment and leverage opportunities
- Negotiates agreements and commitments between business units and functional departments
8
Skills For Provider Engagement Consultant Resume
- Identify, escalate, and communicate systemic issues
- Analyzes business and user needs; documents requirements, and implements the process redesign. Job
- Work to develop and improve EMR capability
- Demonstrate understanding of all Texas Medicaid& Medicare lines of business as they apply to manage care and the needs of the members enrolled in them in order to facilitate their care and resolution of their issues
- Coordinate activities/events with providers to promote the health plan and educate members on value added services and Medicare Extra Benefits offered by the health plan
9
Skills For Senior Products Provider Engagement Consultant Resume
- Advocate the use of Provider Tools, online technology and health plan resources, (e.g. LINK, Provider Manuals)
- A service oriented approach
- Travel requirement 90%
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