Performance Advocate Medicare Advantage Plano, TX

Performance Advocate Medicare Advantage

Full Time • Plano, TX
Job Summary 
The Performance Advocate - Medicare Advantage (PA-MA) is responsible for the Managed Medicare products' engagement and performance for assigned Provider Groups partnering with the Clinically Integrated Network (CIN). The PA-MA serves as the subject matter expert for Network performance (Star Ratings), risk adjustment, and the managed care products' overall framework.  The PA-MA serves as the primary relationship holder between providers, the extended care team, and ancillary providers to enhance the assigned providers' competency and improve all Managed Medicare products. 
  
Role and Responsibilities 
 
  • Responsible for providing leadership and direction to ensure the annual quality submissions are integrated according to technical specifications and deadlines 
  • Creates and presents formal performance reports throughout measurement year to keep Executive management apprised of current status and trend 
  • Provides continuous training and education to all Provider Groups in Managed Medicare products to improve star rating and risk adjustment performance 
  • Develops and maintains a detailed project plan to include milestones, tasks, and targets/actual dates of completion for each practice 
  • Identify opportunities and develops strategies for improved methods to drive Provider Group participation in Managed Care Programs. 
  • Proactively identifies and communicates issues at risk by making suggestions to the providers and implements mitigation and contingency strategies to promote superior CIN performance. 
  • Participate in bi-weekly review analysis with vendors to ensure the plan meets contractual targets, employs creative strategies to create and develop new initiatives to increase plan overall start rating and maintain said rating year over year. 
  • Continuous mindset toward efficiency and process improvement – how to apply technology and processes to improve delivery and efficiency from both the Provider Group and internal perspective 
  • Proactively identify Provider Group’s needs, resolving and communicating concerns or complaints regarding CIN programs to maintain Provider Group satisfaction. 
  • Oversee the maintenance of the Performance Advocates database that includes all participating physicians and ancillary providers for the assigned territory 
  • Professionally always represents the organization; supports the mission, goals, and objectives; participate as a ‘team player”, constantly supporting other staff; sets an example of high personal and professional conduct for employees and others. 
 Qualifications and Education Requirements 
 
  • Bachelor’s degree or Registered Nurse or equivalent clinical work experience.  
  • 1-2 years’ experience in a physician’s office.  
  • Strong client focus (provide examples of success). 
  • Value relationships; demonstrate professional respect and innovative mindset. 
  • Confident working with health care professionals. 
  • Passionate about your work and move forward with purpose; demonstrate clear value and support of your Provider Groups and internal teams.  
  • Exercise judgment to problem solve when the answer is not readily apparent. 
  • Approach problem solving involves systems thinking – understanding how the process works and how your decisions impact people. 
  • Strong communication skills – understanding the need to be inclusive for effective results; communicate effectively with daily operational resources and executive management. 
  • Understand a sense of urgency, fast-paced, and multi-tasking environment; strong organizational skills. 
  • Solutions-oriented, willing to bring Provider Groups results regardless of roles or titles. 
  • Knowledge of star rating, risk adjustment, EMRs, and clinical measures. 
  • Requires daily local travel to provider offices. (mileage reimbursement provided) 
  • Willingness and ability to attend after hour business meetings as needed.  
  • Must maintain a valid driver’s license and use a personal vehicle for travel. 
  • Experience with basic Microsoft Office Applications.  
 




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