Plans and directs activities in the Provider Relations functions. Produces revenue for the corporation through the effective coaching and developing of Representatives to build relationships and manage the accounts of their Providers.
DEPARTMENT: Provider Relations/Network Management
REPORTS TO: Sr. Director, Network Management
- Leads and develops a team of Provider Relations Representatives and Network Management.
- Conducts and directs provider service functions.
- Performs data analysis and develops specific actions to manage medical cost trend.
- Actions have impact upon multiple functional areas.
- Brings resources together in creative ways.
- Conducts ride-alongs with Representatives in the field to develop skills and behaviors and document progress/provide formative feedback through timely and consistent Field Trip Reports.
- Ensures adherence to contractual obligations and to regulatory requirements.
- Analyzes the provider network for trending issues involving provider access, satisfaction and process improvement.
- Assists in developing practices to assist risk partners in managing financial risk. Identifies areas to improve provider service levels.
- Educates/enhances relationships within the provider community.
- Performs strategic planning for membership growth, retention, and to affect sophisticated or complex provider relationships.
- Provides training, mentoring and guidance to new managers.
- Special projects as assigned or directed.
- Leads and develops Provider Operations staff.
- Required a Bachelor's Degree in a related field or equivalent work experience
- Required 6 years of experience in provider relations or similar background
- Required 3 years of management experience
- Preferred HMO/PPO background
- Intermediate ability to lead/manage others
- Advanced knowledge of healthcare delivery Strong functional and technical knowledge of healthcare delivery
- Advanced demonstrated interpersonal/verbal communication skills
- Intermediate ability to influence internal and external constituents
- Advanced ability to effectively present information and respond to questions from peers and management Presentation skills to communicate business plans in an effective manner
- Intermediate facilitative skills
- Advanced knowledge of CMS and state regulations
- Required advanced Microsoft Excel
- Required advanced Microsoft Word
- Required advanced Microsoft PowerPoint
- Required advanced Xcelys, strongly preferred.