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Provider Relations-Networking-Contracting WellCare - PR & Contracting Management Careers

Provider Operations - Senior Manager Job

Full Job Title: Sr Mgr, Provider Operations

Job Number: 1805672

Location: Columbia, SC

Date Posted: 2018-08-09

Functions as the primary point of accountability for all claims research and provider issue resolution for escalated issues. Positions plans, provides resources and directs activities for operational components of Provider Relations.

Essential Functions:
  • Manages Provider Operations team
  • Applies a comprehensive knowledge of claims processing, provider contracts and contract configuration to the day-to-day operationally escalated issues.
  • Serves as primary contact for complex issues
  • Manages and develops direct reports. Directs work assignments, measures results and initiates personnel actions as required for assigned claims unit
  • Manages process improvement initiatives, seeking root cause and developing appropriate corrective action
  • Coordinates operational activities of the provider service unit to meet budget and deadlines and resolves conflicting demands
  • Establishes objectives, schedules, and cost data for the business of the function being managed
  • Manage regulatory inquiries for CMS and DOH.
  • Manages HSD tables and oversees Provider Directory integrity
  • Reviews capitation reports for administrative fees.
  • Manages application tracking system (onmiflow). Manage contracts (new, modifications, terminations). Manages Flat files for delegated providers
  • Troubleshoots complex regional/corporate systemic issues such as contracting, operational or network development issues
  • Ensures corporate initiatives are implemented to achieve optimum results.
  • Performs other duties as assigned.
Additional Responsibilities:
    Candidate Education:
    • Required A Bachelor's Degree in a related field
    Candidate Experience:
    • Required 6 years of experience in Provider Relations, Network Development, customer service, or a related field
    • Required 3 years of management experience
    Candidate Skills:
    • Intermediate Demonstrated leadership skills
    • Intermediate Ability to lead/manage others
    • Intermediate Knowledge of healthcare delivery
    • Intermediate Other Demonstrated facilitative skills
    • Intermediate Ability to drive multiple projects
    • Intermediate Ability to analyze information and covert related activities into a comprehensive work plan
    • Intermediate Demonstrated customer service skills
    • Intermediate Demonstrated interpersonal/verbal communication skills
    • Intermediate Knowledge of community, state and federal laws and resources
    • Intermediate Other Broad knowledge of claims processing, contract details and contract configuration
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Required Intermediate Microsoft Excel
      • Required Intermediate Microsoft Outlook
      • Required Intermediate Microsoft Word
      • Required Intermediate SalesForce
      • Required Intermediate Healthcare Management Systems (Generic)

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        Last Updated On: 12/9/2015