« Back to search
Apply now »
« Back to search
Watch for similar jobs
AVP Provider Relations Job
Date: Dec 7, 2009
Location: Cincinnati, OH, US
Job Description
Job Title:
AVP Provider Relations
Job ID:
10751
Location: Cincinnati, OH
Full/Part Time:
Full-Time
Regular/Temporary:
Regular
------------
Email to Friend Save Job Apply Now
------------
Responsibilities
JOB SUMMARY:
Responsible for providing the Health Plan with expertise in physician, physician group, hospital and ancillary healthcare contracting and provider reimbursement methodologies, taking the lead or assisting on Provider Relations projects in existing, expansion and new markets. Works with senior management to develop contracting and financial strategies, execute strategies, and maintain positive provider relationships while advancing the goals of the Health Plan. Responsible for oversight of Provider Relations staff and servicing activities, including resolution of complex operational issues impacting provider relationships.
PRIMARY RESPONSIBILITIES:
1. Assist Health Plan senior staff in interacting and negotiating with the provider's most senior clinical and administrative executives.
2. Collaborate with the CEO/COO and other Health Plan senior management to determine the Plan's provider contracting needs.
3. Work with Health Plan CEO/COO and other appropriate senior management in the development of provider network business plans, strategies and goals as they relate to network expansion and provider contracting, education, communication, policies, procedures and servicing.
4. Work with Plan senior management to develop provider network related earnings improvement initiatives as well as network growth and expansion initiatives.
5. Develop and implement Provider Relations projects or assignments in support of Health Plan goals and the Home Office.
6. Support Health Plan CEO/COO in the strategic analysis and negotiation of all types of complex Provider contracts.
7. Review financial information and, in collaboration with Medical Finance and other corporate departments, develop effective reimbursement methodologies and strategies to achieve specific contracting and budgetary objectives which are operational and efficient.
8. Monitor local market trends relative to provider contracting, reimbursement and service, make recommendations to modify current processes and assist implementing changes when necessary.
9. Educate Provider Relations staff on the concepts and practice of provider marketing. Assume responsibility for development, implementation, operation and oversight of provider marketing efforts in collaboration with Sales and Marketing leader.
10. When provider issues become escalated, work with senior management to interact with provider senior administrators, set strategy for issues resolution and monitor progress of issues.
11. Work with staff to identify operational issues and implement projects to promote payment of claims on first submission.
12. Supervise the provider network and operations staff to ensure proficiency and efficiency in meeting all Health Plan strategic and operational goals, MJOs and planning goals.
13. Develop and implement strategies to recruit and retain the highest quality staff members.
14. Provide coaching and direction to department directors and other direct reports.
15. Other tasks as assigned.
EDUCATION AND EXPERIENCE:
Education
Required:
• Bachelor's degree in business administration, healthcare administration or related field
Preferred:
• Master's degree
Years and Type of Experience Required:
Required:
• Minimum ten (10) years experience in managed care provider relations/provider network administration, with minimum five (5) years in managed care administration.
Preferred:
• Experience with government programs
Specific Technical Skills
Required:
• Strong understanding of the healthcare industry, managed care and provider financing and operations. Experienced in provider network management, provider contract administration and provider network operations. Proven track record in provider contracting and provider relations. Strong project management experience.
Preferred:
•
Certifications or Licensures
Required:
• Current driver's license, and at minimum, state required amount of automobile insurance for state where automobile is licensed.
Preferred:
•
Other:
Required:
• Results oriented self starter who is goal oriented.
• Strong computational and analytical skills related to provider financing and project management.
• Ability to set expectations and provide clear direction to subordinates and support staff or departments being managed.
• Respect for and ability to work well with all levels within the organization and within the provider community.
• Appreciation of cultural diversity and strong sensitivity towards target member population.
• Excellent communication, writing, organizational and project management skills.
• Ability to prioritize and execute multiple complex projects in various markets simultaneously.
• Ability to complete projects/assignments accurately, on-time, on-budget and with a minimum amount of supervision.
• Understanding and appreciation of legal and regulatory environment relative to Provider Relations, provider contracts and provider financing.
Preferred:
PHYSICAL REQUIREMENTS
• Must be able to travel on common carriers, drive an automobile and adhere to AGP's travel policy.
• Must be able to operate a computer, telephone and other commonly used business-related items.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.
AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.
------------
Email to Friend Save Job Apply Now
------------
Job Title:
AVP Provider Relations
Job ID:
10751
Location: Cincinnati, OH
Full/Part Time:
Full-Time
Regular/Temporary:
Regular
------------
Email to Friend Save Job Apply Now
------------
Responsibilities
JOB SUMMARY:
Responsible for providing the Health Plan with expertise in physician, physician group, hospital and ancillary healthcare contracting and provider reimbursement methodologies, taking the lead or assisting on Provider Relations projects in existing, expansion and new markets. Works with senior management to develop contracting and financial strategies, execute strategies, and maintain positive provider relationships while advancing the goals of the Health Plan. Responsible for oversight of Provider Relations staff and servicing activities, including resolution of complex operational issues impacting provider relationships.
PRIMARY RESPONSIBILITIES:
1. Assist Health Plan senior staff in interacting and negotiating with the provider's most senior clinical and administrative executives.
2. Collaborate with the CEO/COO and other Health Plan senior management to determine the Plan's provider contracting needs.
3. Work with Health Plan CEO/COO and other appropriate senior management in the development of provider network business plans, strategies and goals as they relate to network expansion and provider contracting, education, communication, policies, procedures and servicing.
4. Work with Plan senior management to develop provider network related earnings improvement initiatives as well as network growth and expansion initiatives.
5. Develop and implement Provider Relations projects or assignments in support of Health Plan goals and the Home Office.
6. Support Health Plan CEO/COO in the strategic analysis and negotiation of all types of complex Provider contracts.
7. Review financial information and, in collaboration with Medical Finance and other corporate departments, develop effective reimbursement methodologies and strategies to achieve specific contracting and budgetary objectives which are operational and efficient.
8. Monitor local market trends relative to provider contracting, reimbursement and service, make recommendations to modify current processes and assist implementing changes when necessary.
9. Educate Provider Relations staff on the concepts and practice of provider marketing. Assume responsibility for development, implementation, operation and oversight of provider marketing efforts in collaboration with Sales and Marketing leader.
10. When provider issues become escalated, work with senior management to interact with provider senior administrators, set strategy for issues resolution and monitor progress of issues.
11. Work with staff to identify operational issues and implement projects to promote payment of claims on first submission.
12. Supervise the provider network and operations staff to ensure proficiency and efficiency in meeting all Health Plan strategic and operational goals, MJOs and planning goals.
13. Develop and implement strategies to recruit and retain the highest quality staff members.
14. Provide coaching and direction to department directors and other direct reports.
15. Other tasks as assigned.
EDUCATION AND EXPERIENCE:
Education
Required:
• Bachelor's degree in business administration, healthcare administration or related field
Preferred:
• Master's degree
Years and Type of Experience Required:
Required:
• Minimum ten (10) years experience in managed care provider relations/provider network administration, with minimum five (5) years in managed care administration.
Preferred:
• Experience with government programs
Specific Technical Skills
Required:
• Strong understanding of the healthcare industry, managed care and provider financing and operations. Experienced in provider network management, provider contract administration and provider network operations. Proven track record in provider contracting and provider relations. Strong project management experience.
Preferred:
•
Certifications or Licensures
Required:
• Current driver's license, and at minimum, state required amount of automobile insurance for state where automobile is licensed.
Preferred:
•
Other:
Required:
• Results oriented self starter who is goal oriented.
• Strong computational and analytical skills related to provider financing and project management.
• Ability to set expectations and provide clear direction to subordinates and support staff or departments being managed.
• Respect for and ability to work well with all levels within the organization and within the provider community.
• Appreciation of cultural diversity and strong sensitivity towards target member population.
• Excellent communication, writing, organizational and project management skills.
• Ability to prioritize and execute multiple complex projects in various markets simultaneously.
• Ability to complete projects/assignments accurately, on-time, on-budget and with a minimum amount of supervision.
• Understanding and appreciation of legal and regulatory environment relative to Provider Relations, provider contracts and provider financing.
Preferred:
PHYSICAL REQUIREMENTS
• Must be able to travel on common carriers, drive an automobile and adhere to AGP's travel policy.
• Must be able to operate a computer, telephone and other commonly used business-related items.
Equal Employment Opportunity
In accordance with state and federal laws, employment offers are tendered solely on the basis of qualifications without regard to race, religion, color, national origin, age, sex, marital status, sexual orientation, handicap (including disabled veterans) or Vietnam Era veteran status.
AMERIGROUP administers pre-employment drug testing as a condition of employment and a satisfactory criminal history background report.
------------
Email to Friend Save Job Apply Now
------------
Nearest Major Market: Cincinnati
Job Segments: Management, VP
Apply now »
| Find similar jobs: | Cincinnati Contract Administrator Jobs, Cincinnati Customer Service Jobs, Cincinnati Healthcare Administration Jobs, Cincinnati Healthcare Jobs, Cincinnati Managed Care Jobs |
« Back to search