Provider Network Manager

Abilis Health Plan • Louisville, KY

1d

About The Position

The Provider Network Manager is responsible for maintenance and management of an adequate provider network by fostering relationships with providers.

Requirements

• Bachelor’s Degree in business or health related discipline such as Healthcare Administration or Healthcare Management
• Provider servicing experience
• Knowledge in provider data base management
• Excellent verbal and written English communication skills
• Demonstrated intermediate to advanced skills in Microsoft Word, Excel, Power Point and Outlook, Internet and Intranet navigation
• Highest level of professionalism with the ability to maintain confidentiality
• Ability to communicate at all levels of organization and work well within a team environment in support of company objectives
• Customer service oriented with the ability to work well under pressure
• Strong attention to detail and accuracy, excellent organization skills with ability to prioritize, coordinate and simultaneously maintain multiple projects with high level of quality and productivity
• Strong analytical and problem-solving skills
• Ability to take initiative and make suggestions for improvements
• Ability to work with minimal supervision, take initiative and make independent decisions
• Ability to deal with new tasks without the benefit of written procedures
• Approachable flexible and adaptable to change
• Function independently, and have flexibility, personal integrity, and the ability to work effectively with stakeholders and vendors

Nice To Haves

• Two to three years Medicaid and/or Medicare experience preferred

Responsibilities

• Identify and participate in process improvement initiatives that improve the customer experience, enhance workflow, and/or improve the work environment
• Monitoring of various reports and collaborating with leadership to ensure all requirements are met and maintained
• Management duties including, but not limited to, hiring, training, and developing, coaching and counseling, and terminating department staff, as deemed necessary
• Reporting to leadership current status, risks, and potential opportunities in area of responsibility
• Maintaining and analyzing network adequacy to quickly identity service gaps
• Ensures provider data base is accurate and up to date
• Oversees provider contracts by ensuring all credentialing documentation is received, documented, and stored per CMS requirements
• Evaluates and monitors contract performance to determine necessity of amendments or extensions of contracts
• Analyzes service agreements, financial reports, and other data to determine reasonableness of contracts
• Collaborating with Sales, Account Managers, and Credentialing to solve provider issues
• Participate in process improvement initiatives that improve the customer experience, enhance workflow, and/or improve the work environment
• Identifying contracting needs and collaborating with team to secure and negotiate needed contracts
• Assisting with negotiating and renegotiating contracts with physicians and provider groups as assigned
• Responsible for working and resolving provider disputes as necessary

What This Job Offers

• Job Type: Full-time
• Career Level: Manager