Join Our Team: Make a difference in the lives of others. Join our team today! Overview:
Elderwood Health Plan has an exciting and rewarding opportunity for Provider Relations Manager.
The Provider Relations Manager is responsible for managing the day-to-day activities of the provider relations department and staff. Responsible for assisting with departmental activities related to provider satisfaction, education, and communication. This position is also responsible for provider network recruiting and contract management activities in its six service counties. Ensures the department and staff remain current in all aspects of Federal and State rules, regulations, policies and procedures and creates or modifies departmental policies to reflect changes. Ensures department achieves annual goals and objectives. The Provider Relations Manager may be required to travel for meetings with a variety of provider groups; including but not limited to, in-network providers. Will be responsible for monitoring provider network adequacy, contracting, pnds accuracy and provider relationship management.
$31.00-$38.00 starting range based on experience and education
Employee Perks!: 401K Retirement Plan with Company Match, Free On-Site Parking, Generous PTO & holiday package, Life Insurance, Medical, Dental, and Vision insurance, Point-earning employee reward program: redeem for prizes!, Substantial employee referral program Responsibilities:
Essential Job Functions
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Over sees all aspects, implementation and provisions of contracting and provider relations.
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Direct oversight of Provider Relations Staff.
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Continuously manage a broad base of providers and services.
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Use Excel and TruChart to track and report on provider network as needed.
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Conduct quarterly reviews of contract relationships and resolve problems to build and maintain positive partnerships.
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Works with finance and compliance officer to initiate provider audits.
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Partner with care management team to identify and measure methods to improve process and workflow.
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Provide assistance regarding education, contract questions and non-routine claims.
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Manage provider network relationships through contract negotiations, network development to prevent network deficiencies, and ensure credentialing policies are followed and maintained.
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Serving as a knowledge and resource expert regarding the most complex provider issues impacting provider satisfaction.
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Works with Executive Director to ensures compliance with all state and federal regulations regarding provider contracting.
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Works with the Executive Director, Director of Clinical Operations, Director of Business Development, Director of Finance and other management staff to provide effective leadership and vision. Creates and generates reports to keep management informed of the current and anticipated network adequacy.
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Supervise and coach provider relations staff.
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Perform other related duties and responsibilities as directed.
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Collaborate with other professionals within the organization and in the community.
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Demonstrate a clear understanding of EHP mission, purpose, and philosophy.
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Adhere to ethical business practices by striving to perform in a manner that conforms to the highest standards of ethical behavior, integrity, and honesty.
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Take initiative and responsibility for decisions as an individual and as a company.
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Participate in the ongoing development of competencies, capabilities, technology, and the resources needed to achieve high standards of efficiency and effectiveness.
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Approach everything with the passion and desire to meet the highest standards.
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Treat employees, members, providers and business partners with respect. Foster teamwork by trusting and supporting each other while encouraging collaboration at all levels of the organization. Embrace diversity and demonstrate the ability to work together.
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Maintain confidentiality of all agency and member related information. Protect member rights as defined in the Member Bill of Rights.
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Maintain proper attendance and punctuality to ensure that the department is operated in an efficient and cost-effective manner.
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Adhere to departmental and agency dress codes.
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Utilize material, equipment, and time in a safe, beneficial, and cost-effective manner.
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On an ongoing basis identify and coordinate contact with new providers.
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Other duties as required by management.
Base salary starting at (note: salary increases with experience):: USD $31.00/Hr. Qualifications:
- Bachelor’s Degree in a related field required
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Four (4) years experience working in a managed care environment, serving in a provider relations, contract management or equivalent role.
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Minimum of one (1) year experience working with an infirmed or elderly population.
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Must be in good standing with the Medicare and Medicaid programs.
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Bilingual skills are preferred, but not required.
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Must provide own transportation and possess a clean driving record.
EOE Statement: WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.