Manager Provider Relations

Univera Healthcare•Binghamton, NY

About The Position

Summary: The Manager of Provider Relations manages the staff that serves as the primary contact for participating Providers. This includes managing the internal and external operations of the department, training, prioritizing assignments, auditing, and interacting with external customers as well as effectively communicating amongst cross-divisional teams. In addition to providing oversight to the regional outreach and education plan, the manager also develops training and education plans designed to assist providers for use in all regions. The Manager will handle special projects, participate on task forces, quality teams, and act as department liaison. Essential Accountabilities: Oversees the regional Provider Relations daily activities, reviews the monthly metrics, identifying opportunities for process improvement and increased productivity. Establishes and maintains effective relationships with all regional providers including institutional, ancillary, and professional to ensure mutual understanding of operational functions, efficient business practices, administrative procedures and provider requirements. Accompanies staff on provider visits in order to assess performance and problem solve complicated issues impacting providers. Assists in the development and maintenance of departmental policy on performance standards. Assists in development and contributes regional action planning for annual physician satisfaction organization wide workplan. Travel occasionally to community events and/or provider meetings outside of standard business hours to lead relationship building and outreach efforts within the community. This flexible schedule, including some evenings or weekends, may be necessary to support the department and direct reports. Meets with leadership from key provider groups to assess our performance, troubleshoot complicated operational issues, and foster improved relations. Develops curriculum and implements provider education training for all regions through face to face or virtual visits and classroom training or webinars. Coordinates with internal departments to manage work inventory across organization to ensure that provider issues are prioritized and addressed in a timely manner and in accordance with all regulatory requirements. Ensures that all reps within own region are responding to provider issues in a timely manner. Coordinates, in conjunction with Provider Communications, written communication that reflects Health Plan initiatives, trends, and opportunities for improved efficiencies. Responsible for recruitment strategy, network development, contracting and credentialing to ensure an adequate provider network. Maintains regular communication to staff on critical issues and Health Plan initiatives. Leads Health Plan initiatives and project teams in order to identify opportunities to improve efficiencies for providers and assist providers with ongoing changes in programs and policies. Serves as an internal expert to coordinate appropriate resources for problem resolution for providers. Resolves complex problems related to provider reimbursement, provider payments and remittances or contract adjudication with appropriate plan department managers. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are compliant with these requirements. Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information. Regular and reliable attendance is expected and required. Performs other duties and functions as assigned by management.

Requirements

Minimum of four years’ experience in related field with relevant and progressive business experience working in managed care or other health care related field with significant interface with physicians and/or hospitals.
Bachelor’s degree Business Administration, Health Care Administration, Communications preferred.
Minimum of three years management experience.
Curriculum development skills required.
Significant, demonstrated experience interfacing with providers on a variety of contact points, face-to-face, on phone and in written communication.
Understanding of medical care delivery and local market dynamics.
Knowledge of Provider and Member contracts, services offered, and operational policies and procedures; care management programs and their impact to Providers and Members; and claims and membership systems.
Excellent written and verbal communications skills and possess the ability to present information to a variety of professional audiences.
Strong interpersonal and relationship building skills; ability to develop partnerships internally and externally.
Analytical ability to analyze and report on internal and external data and trends. Able to present these findings to all levels of management.
Ability to travel across New York State.
Ability to work while sitting and/or standing while at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
Ability to work in a home office for continuous periods of time for business continuity.
Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
Must have a valid Class D license and ability to operate a motor vehicle.
The ability to hear, understand and speak clearly while using a phone, with or without a headset.

Responsibilities

Oversees the regional Provider Relations daily activities, reviews the monthly metrics, identifying opportunities for process improvement and increased productivity.
Establishes and maintains effective relationships with all regional providers including institutional, ancillary, and professional to ensure mutual understanding of operational functions, efficient business practices, administrative procedures and provider requirements.
Accompanies staff on provider visits in order to assess performance and problem solve complicated issues impacting providers. Assists in the development and maintenance of departmental policy on performance standards. Assists in development and contributes regional action planning for annual physician satisfaction organization wide workplan.
Travel occasionally to community events and/or provider meetings outside of standard business hours to lead relationship building and outreach efforts within the community. This flexible schedule, including some evenings or weekends, may be necessary to support the department and direct reports.
Meets with leadership from key provider groups to assess our performance, troubleshoot complicated operational issues, and foster improved relations.
Develops curriculum and implements provider education training for all regions through face to face or virtual visits and classroom training or webinars.
Coordinates with internal departments to manage work inventory across organization to ensure that provider issues are prioritized and addressed in a timely manner and in accordance with all regulatory requirements. Ensures that all reps within own region are responding to provider issues in a timely manner.
Coordinates, in conjunction with Provider Communications, written communication that reflects Health Plan initiatives, trends, and opportunities for improved efficiencies.
Responsible for recruitment strategy, network development, contracting and credentialing to ensure an adequate provider network. Maintains regular communication to staff on critical issues and Health Plan initiatives.
Leads Health Plan initiatives and project teams in order to identify opportunities to improve efficiencies for providers and assist providers with ongoing changes in programs and policies. Serves as an internal expert to coordinate appropriate resources for problem resolution for providers.
Resolves complex problems related to provider reimbursement, provider payments and remittances or contract adjudication with appropriate plan department managers.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are compliant with these requirements.
Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.
Regular and reliable attendance is expected and required.
Performs other duties and functions as assigned by management.