Provider Escalation & Education Senior Associate

Job Description

A bit about this role: 

The Provider Escalation & Education (Prov Esc/Edu) team is dedicated to maintaining strong operational relationships with our Critical Provider Organizations (CPOs) while focused on building partnerships that reduce frustration through efficient issue management and proactive solutions. Our mission is to minimize unnecessary friction and demonstrate true partnership with our provider partners, solidifying Devoted as the health plan of choice and the preferred partner for provider organizations.

In this role, the associate will support the development of a streamlined process for managing payment integrity issues and other escalations from providers. Collaboration with various departments will be essential to identify, triage, and resolve these issues efficiently, ensuring a smooth workflow and maintaining the integrity of payment processes. Expertise will contribute directly to enhancing operational efficiency and fostering a culture of continuous improvement.

Your Responsibilities and Impact will include: 

• Act as a point of contact for escalated issues, providing expertise and guidance.

• Support development of a structured process for triaging payment integrity issues and escalations.

• Lead the triage discussions, ensuring that all relevant stakeholders are involved in problem-solving.

• Collaborate with cross-functional teams to identify and prioritize issues based on their impact.

• Monitor the resolution process and provide regular updates to stakeholders on status and outcomes.

• Analyze trends in payment integrity issues and recommend preventative measures.

• Create detailed documentation of issues, resolutions, and processes for future reference and training.

• Facilitate training sessions for team members on new procedures and best practices for issue resolution.

Required skills and experience: 

• Strategic analytical horsepower: Proven ability to leverage complex data sets to inform strategic initiatives and team development, while articulating compelling, data-driven narratives that drive organizational vision and ensure alignment.

• Operations minded: define an endpoint and formulate & execute against a plan for getting there, with quantifiable mile markers along the way.

• Relationship builder: expert at building relationships with a broad range of internal and external stakeholders (provider groups).

• Communication skills: conversational agility expertise demonstrated by the ability to reframe, refocus, and redirect conversations to realize accretive partnerships and desired outcomes.  Additionally, this individual needs to be able to condense complex concepts into simple explanations with clear and concise calls to action.

• Organization skills: super organized with an eye for detail and the ability to understand and document what matters. Staying organized is a critical component of being able to pivot between going deep into the details and stepping back to see themes or levers that inform strategy.

• Writing Skills: Strong writing ability to craft thoughtful, clear, and persuasive communications to providers, ensuring messages are data-driven and tailored to meet specific needs and contexts.

Desired skills and experience: 

• Proven ability to thrive in a fast-paced startup environment

• Capacity for high throughput, while working both autonomously and collaboratively with others

• Proven experience in process development, payment integrity, or issue resolution in a fast-paced environment.

• Strong analytical skills with the ability to identify root causes and develop effective solutions.

• Excellent communication and interpersonal skills to collaborate effectively with various teams.

• Detail-oriented approach with a strong focus on accuracy and quality.

• Ability to manage multiple tasks simultaneously and meet deadlines.

Salary range: $54,000 - $91,000 /year

Our ranges are purposefully broad to allow for growth within the role over time. Once the interview process begins, your talent partner will provide additional information on the compensation for the role,