Job Summary
This position manages the programs designed to foster positive relations between physicians and organizations insurance plan and network of physicians and hospitals. Must be familiar with a variety of managed care concepts, practices and procedures while increasing the provider network.
Essential Functions
Oversees the daily operations of the provider relations functions. This includes providing input on employment decisions, orienting new employees, preparing work schedules, monitoring staff productivity and providing performance evaluations.
Manages the activities of the external provider relations employees including provider education, problem resolution, recruiting, and service monitoring and contracting activities.
Manages the activities of the internal provider relations employees including working the claims buckets, loading new contracts, physician updates and problem resolution.
Manages the activities of practice support agreement providers to ensure the providers are credentialed with a variety of managed care payors.
Participates in organizational audits to ensure organizational compliance with health plan requirements.
Manages activities related to the preparation of provider manual, provider notification materials and contributes to other publications as requested.
Serves as an integral part of the team tasked to develop and implement the emergency on-call program for the organization.
Provides expertise to the provider relations staff, physicians, health plan personnel and other departments on benefits, reimbursement and contract/regulatory changes.
Minimum Qualifications
Must possess a strong knowledge of business and/or healthcare as normally obtained through the completion of a bachelors degree in business, healthcare or related field.
Must possess a strong knowledge and understanding of healthcare planning and management as normally demonstrated through three to five years of managed care and management experience. Provider relations experience required.
This position requires a thorough knowledge of managed care and governmental reimbursement methodologies, the ability to analyze financial ramifications of decisions, excellent interpersonal skills and exceptional organizational abilities. Must be able to communicate effectively with others by speaking, reading, and writing. Relies on extensive experience and judgment to plan and accomplish goals.
Preferred Qualifications
Additional related education and/or experience preferred.
