Sr. Provider Network Manager

UHS•Reno, NV

About The Position

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Prominence Health creates value for populations and providers to strengthen integrated partnership, advance market opportunities, and improve outcomes for our patients and members. Founded in 1993, Prominence Health started as a health maintenance organization (HMO) and was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. Prominence Health serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience. Job Summary: The Sr. Manager of Provider Network leads and manages provider contracting and network developments consistent with the strategic goals of Prominence Health Plan & is responsible for ensuring the satisfaction of Plan Participating Providers by maintaining excellent relationships and facilitating growth and retention. This position is responsible for the development and maintenance of a comprehensive network of physician, hospital, ancillary and supplemental service providers throughout the assigned area, which meets state, federal and accreditation requirements and standards. Responsibilities include effective provider communications and network management, contract negotiations, in depth rate analysis and initial and ongoing education and support for all network products. The Sr. Manager of Provider Network analyzes specific issues pertaining to providers and oversees the management, problem resolution and education of the provider network on Prominences’ products, services policies and procedures. Facilitates the development and implementation of educational strategies to effectively communicate to Prominence Health Plan providers and other key audiences as well as current and ongoing educational initiatives.

Requirements

Bachelor’s degree or equivalent experience required.
Five years’ working experience in managed care.
Experience in working with medical claims billing/payment processes.
Experienced in negotiating provider rates schedules that can achieve the best possible rates per provider, per line of business and can be automated in various claims billing systems.
Experienced in analyzing rates, negotiating contracts and preparing documents i.e., Agreements, amendments, reports, analysis, addendums and letters of agreement.
Ability to develop and implement strategic initiatives.
Understanding of provider office dynamics and optimal approaches to communicating and educating providers and provider staff.
Understanding of provider reimbursements and coinciding challenges (FFS, CPT code reimbursement, etc.).
Ability to effectively communicate in English, both verbally and in writing.
Excellent computer skills.
Highly developed professional, interpersonal, written and oral communication skills.
Experience in building and maintain provider relationships.
Highly accountable, organized, detailed.
Ability to develop and implement strategic initiatives.

Nice To Haves

Knowledge of provider reimbursement, Medicare reimbursement, coding and HEDIS Measures and care gap reporting preferred.
Knowledge of Medicare Advantage and ACA risk scores and ability to educate providers and key levers to further enable the health plan’s success

Responsibilities

Leads and manages provider contracting and network developments consistent with the strategic goals of Prominence Health Plan.
Ensures the satisfaction of Plan Participating Providers by maintaining excellent relationships and facilitating growth and retention.
Develops and maintains a comprehensive network of physician, hospital, ancillary and supplemental service providers throughout the assigned area, which meets state, federal and accreditation requirements and standards.
Manages effective provider communications and network management.
Negotiates contracts.
Conducts in-depth rate analysis.
Provides initial and ongoing education and support for all network products.
Analyzes specific issues pertaining to providers.
Oversees the management, problem resolution and education of the provider network on Prominences’ products, services policies and procedures.
Facilitates the development and implementation of educational strategies to effectively communicate to Prominence Health Plan providers and other key audiences as well as current and ongoing educational initiatives.