Provider Relations Network Manager - Ohio

Trinity Health•Columbus, OH

About The Position

Why MediGold? MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more. Position Purpose: . Provider Relations & Network Manager is responsible for provider relations and service interactions including contracting and recruitment, issue resolution and escalations, strategy development and execution, education, and retaining MediGold Contracted Providers. Serves as the primary point of contact for the Providers and will require extensive relationship building, driving the resolution of complex issues, and MediGold brand building. Assists the Director, Provider Relations & Contracting in developing provider collaborations that ensure network growth and meet quality/efficiency targets.

Requirements

Education: Bachelor's degree in Healthcare Administration, Finance, related field or equivalent experience.
Experience: Minimum five years of experience with a Health Plan or Health Provider.
Prior contracting and network development experience highly preferred
Knowledge of physician claims coding and Provider reimbursement payment methodologies
Ability to interpret Provider contracts
Establish and maintain relationships with Providers to ensure quality and satisfaction of services provided
Working knowledge of protocols and procedures of Centers for Medicare and Medicaid Services
Valid driver's license
Requires use of a personal vehicle with valid auto insurance.

Responsibilities

Recruit providers to build a cost effective and high quality provider network within MediGold guidelines.
Serve as the MediGold point of contact within the Provider network.
Addresses customer complaints by directly handling the issue, working with the correct department(s) to resolve, or escalating as required.
Engage Providers to develop, coordinate, and lead training and distribution of materials.
Proactively drive communications with Providers via telephone/email and onsite visits.
Collaborates with the Director - Provider Contracting and Network Development to develop communication goals, strategies, and plans.
Negotiates provider contracts within MediGold guidelines and financial standards.
Manages successful implementation of provider contracts, including interpretation of payment and reimbursement terms.
Maintains excellent working relationships with MCHP's provider network, internal department management, other business partners, and Mount Carmel Health System related entities.
Travel as required.
Use of personal vehicle for Provider visits required.
All other duties as assigned.

Benefits

Mount Carmel Health System recognized by Forbes in 2025 as one of America’s Best State Employers.
Competitive compensation and benefits packages including medical, dental, and vision with coverage starting on day one.
Retirement savings account with employer match starting on day one.
Generous paid time off programs.
Employee recognition programs.
Tuition/professional development reimbursement starting on day one.
RN to BSN tuition 100% paid at Mount Carmel’s College of Nursing.
Relocation assistance (geographic and position restrictions apply).
Employee Referral Rewards program.
Mount Carmel offers DailyPay - if you’re hired as an eligible colleague, you’ll be able to see how much you’ve made every day and transfer your money any time before payday. You deserve to get paid every day!
Opportunity to join Diversity, Equity, and Inclusion Colleague Resource Groups.