Alliance Health

Support Specialist

• Handle calls from providers and answer questions about network joining, contracts, enrollment, billing, member information, EHR navigation, claims submissions, authorization requests, onboarding, technology platforms, and NCTracks
• Provide coverage of the Provider Network Helpdesk phone within department expectations
• Guide providers through credentialing initiation during network expansion
• Assist providers with EHR and other portal platforms
• Respond to written and email information requests
• Help providers navigate the provider handbook, Alliance website, forms lists, and other resources
• Troubleshoot basic IT issues, including password resets and changes
• Respond to questions regarding claims and utilization management requirements
• Research agency procedures, software, and agency contacts to answer complex provider questions
• Identify and report Helpdesk request and communication trends to the Supervisor
• Contact providers regarding EHR calendar use and agency listing maintenance
• Maintain departmental resources and provide administrative support
• Maintain provider specialty lists and the departmental Agency Listing
• Maintain the insurance tracking database, current availability, and provider contract status
• Document work in supported software to meet oversight-agency expectations
• Screen and route materials; provide receptionist and telephone services
• Proofread documents as requested
• Monitor and complete tasks related to incoming department-inbox emails

Provider Support Line Specialist

Customer Support

• Provide care team support for members transitioning from inpatient settings to appropriate lower or lateral levels of care
• Provide subject matter expertise within scope regarding members' physical and/or behavioral health to support whole-person care management
• Collaborate with Alliance staff, behavioral health providers, primary care physicians, specialty care providers, community partners and stakeholders
• Support High Priority Reentry Liaison Transition Coordinator functions
• Meet with clients regularly, including travel, to provide one-on-one support and counseling
• Develop recovery plans, short-term goals, coping methods and rehabilitation strategies with clients
• Arrange medical appointments, therapy sessions, support groups and other resources
• Report unusual behavior, conflicts, recovery deviations, challenges, conflicts or barriers to relevant professionals and the High Priority Reentry Liaison Transition Coordinator
• Liaise regularly with family members and medical professionals
• Coordinate client logistics and address barriers to appointments, treatments and services
• Travel between Alliance offices, attend meetings and Alliance-sponsored events, meet members and providers, engage stakeholders, and attend court hearings as required

Reentry Peer Support Specialist

Evaluator

• Conduct and lead Clinical Quality Reviews, Oversight Reviews, and Plan of Correction implementation reviews of contracted MH/IDD/SUD service providers
• Lead, guide, support, and peer review team members’ work to ensure inter-rater reliability
• Ensure contracted providers apply best practices, clinical guidelines, and regulatory requirements
• Review paid claims data, clinical documentation, and personnel materials against applicable standards, policies, procedures, and regulations
• Identify and substantiate clinical quality concerns, health and safety risks, service-planning gaps, and regulatory or administrative noncompliance
• Distinguish isolated deficiencies from systemic patterns and assess potential impact on members
• Provide technical assistance and monitor corrective actions through closure when a Plan of Correction is required
• Interpret provider manuals, clinical coverage policies, scopes of work, ILOS, contracts, and governing standards
• Report monitoring outcomes and potential impacts to the Provider Network Evaluator Supervisor and Director of Provider Network Evaluation
• Apply advanced clinical expertise and treatment-modality knowledge to interpret provider information and document findings
• Assist with standardized monitoring tools, guidelines, department policies, procedures, standards, and clinical quality standards
• Develop monitoring policies and procedures for behavioral health, substance use, and I-DD services
• Maintain provider database information gathered from monitoring activities
• Develop quality indicators and provider profile elements in collaboration with Service Management
• Maintain knowledge of services and supports available within the Alliance catchment area and North Carolina
• Provide technical assistance to providers, stakeholders, and internal Alliance Health departments
• Support Provider Network Evaluation teams and external Alliance units by sharing clinical information
• Travel between Alliance offices, meet providers and stakeholders, attend meetings, events, and court hearings as required

Provider Network Evaluator II – Clinical Quality

Data Analyst

• Support the design, development, and implementation of care management reporting requirements
• Conduct quality assurance testing related to reporting, data integrity, and analyses
• Monitor and oversee operational reports
• Act as an interdepartmental liaison for Care Management data collection and report development
• Perform data acquisition, analysis, and evaluation using advanced platform queries, MicroStrategy, Excel, and other data management tools
• Design reporting solutions, dashboards, and alerts to maximize efficiency
• Design reports merging data from State data, the data warehouse, Jiva, Excel, and SharePoint
• Ensure accuracy of reports and metrics for external and internal stakeholders
• Support data assurance and integrity efforts and completion and validation of state-required reports
• Engineer processes for gathering statistical data, identifying trends, and translating insights into actionable recommendations
• Implement Lean Six Sigma or similar process improvement methodologies
• Maintain records of actions supporting efficient processes and data integrity
• Write report requirements, submit requests, and coordinate report development with IT resources
• Monitor changes in workflows and reporting requirements and quality-control updates
• Analyze Care Management activities and data, translate findings into report documentation specifications, and present data
• Support operational documentation platform workflows
• Lead clarification of unclear specifications
• Collaborate with Care Management leadership and operations to improve workflows and reporting
• Oversee ongoing non-automated reporting
• Manage timelines and coordinate with Care Management, IT, and other internal teams
• Conduct peer reviews and test solutions for functionality and data accuracy
• Provide end-user support and data interpretation
• Support communication and training on processes impacting reporting
• Attend relevant trainings, meetings, committees, work groups, and in-person meetings as required

Senior Data Operations Analyst, Care Management

AI Engineer

• Design, develop, deploy, and integrate machine learning models, AI tools, and analytics products into Alliance systems and workflows
• Improve member health, quality of services, and administrative processes through AI/ML solutions
• Establish foundational platforms and processes for developing and sustaining machine learning and artificial intelligence capabilities
• Collaborate with technical managers and cross-functional teams to build and deploy AI/ML models and solutions
• Analyze medical claims, electronic health records, and care management records to identify opportunities for process and care improvement
• Develop analytics problem statements and modeling objectives from care management and administrative use cases
• Iteratively develop data pipelines, AI/ML models, and supporting code
• Evaluate internal and third-party AI/ML models and tools using evaluation pipelines and appropriate metrics
• Collaborate with application development, external vendors, and internal IT teams to deploy and sustain AI/ML models and tools
• Design and implement model/tool monitoring reports or dashboards
• Help establish internal processes governing AI/ML development, evaluation, deployment, and sustainment
• Contribute to internal and/or cloud-based infrastructure for AI/ML projects
• Develop reusable data processing or modeling libraries and reusable features
• Adhere to patient privacy, confidentiality, information security, legal, regulatory, internal policy, and ethical requirements
• Communicate with technical and non-technical stakeholders and present analyses, evaluations, and recommendations
• Share knowledge about AI/ML tools, case studies, impacts, and opportunities
• Stay current on relevant AI/ML software, tools, modeling techniques, advances, and managed-care use cases

Provider Support Line Specialist

Reentry Peer Support Specialist

Provider Network Evaluator II – Clinical Quality

Senior Data Operations Analyst, Care Management

Artificial Intelligence Engineer