The Manager, Professional Relations West has management responsibility for the Professional Relations service team for the Rochester and Buffalo regions. Provides overall management, including staffing, training, and coaching, to the Professional Relations Representatives. Responsible for relationship management with the IPA and large physician groups. Oversees the physician termination and physician non-compliance processes, as well as any other regulatory requirements. Evaluates trends within the physician and office communities and provides reports and recommendations of the findings. Ensures professional relations issues are recognized, considered and addressed whenever policies, practices, previously announced plans or other changes are contemplated that may affect physicians. Functions as a strong provider advocate and is proactive in the areas of issue resolution and policy development for the region. Delegates project responsibilities to individual PR reps ensuring PR representation on regional and enterprise-wide projects. Performs other duties as assigned.
Minimum Education: BA preferred and/or directly related equivalent experience.
Minimum Experience: Health insurance experience and health care fee schedules/methodologies knowledge required. Prior Network Development or Professional Relations experience.
" Comprehensive knowledge of claims, fee schedules and methodologies for physicians, facilities, integrated delivery systems, IPA's, and PO's.
" Detail-oriented with excellent organizational skills.
" Strong computer knowledge including proficiency in Excel, PowerPoint, Access, and Word, as well as experience with claims payment systems/health care systems.
" Team player with good communication skills, interested in serving as a resource to the department and the company. Ability to lead large group meetings. Ability to develop and present large group presentations.
" Experience communicating with upper level executives (Directors, CFO's, CEO's, and VP's).
" Travel throughout the region and surrounding territory.
" Previous supervisory or management experience in a health care field is preferred.
" Strong provider relations experience.
MVP Health Plan covers about 650,000 most valuable people. Also known as MVP Health Care, the company provides health insurance and employee...