: Full Time
Starting with job offers dated February 1, 2012 and after, Geisinger Health System will no longer hire applicants who use tobacco products, including cigarettes, cigars and chewing or smokeless tobacco. Applicants will be screened for nicotine as part of the pre-employment physical process. Nicotine will be part of the urine drug screen. Applicants who test positive for nicotine will not be offered employment. Applicants who test positive may re-apply for jobs with Geisinger in six months.
As a member of the Provider Network Management team, the dual role of Senior Provider Network Development/Provider Relations Associate acts as the primary liaison between Geisinger Health Plan and its participating providers in the development of a positive working partnership.
This position is responsible for physician, ancillary and hospital contracting and for performing ongoing network analysis for all contracts pertaining to all GHP lines of business. Recruits and contracts with providers who meet established criteria to assure adequate geographic and specialty coverage. Provides orientation and ongoing education, compliance monitoring and issue resolution within the managed care regulatory environment. Maintain accurate and current provider databases. Assists with policy and procedure interpretation, assessment and provision of provider training needs.
Reports to the (Regional) Manager, Business Operations (PNM)
COMPETENCIES AND SKILLS:
*Demonstrates ability to prioritize and maintain flexibility in changing priorities.
*Demonstrates the ability to interact effectively with all levels of Health Plan personnel, including Medical Directors and Administrative Leadership.
*Demonstrates strong leadership, organizational, communication, and analytical skills.
*Demonstrates strong communication skills and the ability to conduct presentations to providers and Health Plan administrative staff, including the ability to speak in public.
*Demonstrates the ability to work independently exhibiting strong analytical and problem solving abilities and negotiation skills.
*Demonstrates the ability to maintain a professional appearance in accordance with established department appearance standards.
*Demonstrates provider negotiation and contract development expertise.
*Demonstrates ability to handle complex provider service issues.
*Demonstrates understanding of health care delivery system, particularly physician group practice issues. Exhibits comprehension of basic contract language and regulatory requirements and knowledge of managed care principals.
*Demonstrates proficiency with standard software (Excel, Word, Access, Outlook)
EDUCATION AND/OR EXPERIENCE:
*Bachelor's Degree or equivalent experience required.
*Minimum five year’s experience in provider contract negotiation required.
*Proven ability to handle complex provider service issues.
*Significant experience (5 + years) in benefits interpretation and provider networking strategies preferred.
*Substantive knowledge of managed care policy and direction required.
*Knowledge of ICD-9 and CPT coding preferred.
*Valid driver’s license required.
WORKING CONDITIONS/PHYSICAL DEMANDS:
*Work is typically performed in an office environment.
*Willingness to travel approximately 60 percent of the time.
*Must be willing to accept occasional overnight travel assignments.
*May require evening and weekend work hours.
*Independent travel to sites throughout the system and surrounding communities may be required.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
GEISINGER HEALTH SYSTEM
Geisinger Health System serves nearly 3 million people in Northeastern and Central Pennsylvania and has been nationally recognized for innovative practices and quality care. A mature electronic health record connects a comprehensive network of 4 hospitals, 38 community practice sites and more than 900 Geisinger primary and specialty care physicians.
As a not-for-profit, integrated-delivery health system, Geisinger is a national model of physician-led healthcare delivery. Geisinger is a leading-edge teaching institution with nearly 40 accredited residency and fellowship programs. Geisinger performs cutting-edge laboratory research at The Sigfried and JanetWeisCenter for Research.
The fourth annual Thomson Reuters 15 Top Health Systems study ranks Geisinger as one of the top 15 health systems in the United States. Geisinger was also recently named to the Becker’s Hospital Review “100 Best Places to Work in Healthcare” list for 2011.
Geisinger offers a competitive compensation package beginning day one of hire including comprehensive medical and retirement program benefits, domestic partner benefits, and more.
** Does not qualify for J-1 waiver. We are an Affirmative Action, Equal Opportunity Employer
Women and Minorities are Encouraged to Apply
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