Director Provider Relations
Job ID: 2012-17820
# Positions: 1
Search Category: Health Care Operations
Type: Regular Full-Time (30+ hours)
Posted Date: 1/31/2012
More information about this job:Summary:
Responsible for the management of staff and activities focused on servicing and contracting of physicians and other providers with standard contracts.
Responsible for managing provider issues resolution, education/orientation, evaluation of network adequacy, recruitment and marketing related to physician providers.
Assists Vice President of Provider Relations in assuring that staff is maintaining positive physician relationships, advancing the goals of the Health Plan and promoting consistency with corporate objectives.
1. Manages the Provider Services Team.
Implements and monitors strategic initiatives outlined in the Health Plan’s business plan.
Evaluates the provider network to ensure there is appropriate access for membership.
Develops and implements provider recruitments strategies which support the goals of the Health Plan.
Collaborates with the Medical Management and Marketing departments to assure their network needs are being met.
Manages staff in handling inquiries from providers ensuring appropriate and timely feedback. Takes the lead when issues become escalated and interacts with provider administrators as necessary.
Works with Vice President of Provider Relations to develop and maintain departmental policies and procedures
Recommends and/or drafts communications relative to Health Plan policies and procedures.
Manages staff to achieve goals for office visits and orientations to ensure that providers receive appropriate education regarding Health Plan protocols.
Manages staff to achieve positive relationships between the Health Plan and its providers through timely issues resolution
Manages staff to achieve earnings improvements and strategic goals.
Manages the site visit process as part of the provider credentialing process.
Completes all Provider Relations activities necessary to prepare for the annual State audit.
Oversees the implementation of contracts including monitoring the completion of the credentialing and data entry functions.
Monitors the network to assure the Health Plan is meeting State requirements.
Drafts copy for provider bulletins regarding billing guidelines when necessary.
Manages the provider services activity related to provider marketing initiatives.
Interfaces with all other departments to ensure accurate and appropriate configuration of contracts, database maintenance, provider recoveries, reimbursement rates, benefits configuration, project management, etc.
Participates in standing meetings regarding provider reimbursement and operational issues, network development activities, and other issues as necessary
Represents the Provider Relations Department at senior management meetings when necessary.
Ensures that inventory of provider communication materials is maintained.
Monitors provider concerns and issues, and provides feedback to the Vice President of Provider Relations. Assists in developing and communicating the appropriate response to providers.
Develops and implements action plans regarding provider satisfaction results.
Completes other duties and projects as assigned.
EDUCATION AND EXPERIENCE :
Years and Type of Experience Required:
- BA/BS degree (or equivalent experience).
Specific Technical Skills
- 10 years of managed care experience.
- 5 years Medicaid experience.
- 3 years provider relations or network management experience.
- 3 years management experience.
Certifications or Licensures
- Proficiency with Microsoft computer applications including Outlook, Word, and Excel.
- Knowledge of provider reimbursement methodologies, claims processing, billing practices, and fee schedules.
- Familiarity with provider organizational arrangements; IPA, PHO, Group Practice, etc…
- Strong telephonic and customer service skills.
- Effective presentation skills.
PHYSICAL REQUIREMENTS :
- Leadership skills, ability to take charge when necessary
- Supervisory experience.
- Knowledge of provider compensation and capitation issues.
- Above average negotiation skills.
- Excellent communications and presentations skills.
- Strong analytical abilities.
- Ability to complete multiple projects and to meet deadlines.
- Appreciation of cultural diversity and sensitivity towards target population.
- Must be able to operate a computer.
- Must be able to operate a telephone.
- Must be able to conduct and participate in meetings.
- Must be able to travel locally.
- Must be able to operate a motor vehicle.
- Must be able to travel on common carrier and adhere to AMERIGROUP’s travel policies.
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AMERIGROUP looks after the health of America's needy. The managed health care provider targets people eligible for Medicaid, the State...