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Mgr Provider Relations-Behavioral Health Job
Date: Nov 27, 2009
Location: Nashville, TN, US
Job Title:
Mgr Provider Relations-Behavioral Health
Job ID:
10551
Location: Nashville, TN
Full/Part Time:
Full-Time
Regular/Temporary:
Regular
JOB SUMMARY:
Responsible for daily management and coaching of Provider Services Team. Manages the functions relating to provider servicing, provider education and network development as appropriate in each Plan. Represents the Provider Relations Department at management meetings and interacts with management and staff of other departments as necessary.
PRIMARY RESPONSIBILITIES:
1. Manages the Provider Services Team, including Provider Relations Representatives and Research Specialist(s) and other Provider associates as assigned in the Plan.
2. Monitors team activities to assure that staff meets performance standards and is operating effectively and efficiently.
3. Produces weekly/monthly/quarterly reports via Sales force CRM (or appropriate software per Plan) and reports on departmental metrics.
4. Responsible for handling escalated claims/operational issues and taking action to assure timely resolution of provider issues.
5. Evaluates the provider network to ensure appropriate access for membership and develops/executes recruitment plans.
6. Monitors staff workloads and makes recommendations on distribution of work.
7. Provides coaching and training to direct reports.
8. Recommends and/or drafts provider communications relative to health plan policies and procedures.
9. Oversees provider education activities including development of presentations for orientations and education.
10. Promotes positive relationships with the provider community and other AMERIGROUP departments.
11. Supports earnings improvement initiatives.
12. Manages the site visit process as part of provider credentialing.
13. Oversees provider marketing activities.
14. Interfaces with all other departments to ensure appropriate configuration of contracts, reimbursement rates, and benefits, and to address claims and operational issues.
15. Participates in standing meetings as necessary.
16. Ensures that inventory of provider communication materials is maintained.
17. Manages the provider complaint and Provider Relations databases.
18. Monitors provider complaints and makes recommendations to Directors and Vice President for addressing provider issues.
19. Develops and implements action plans regarding provider satisfaction results.
20. Leads provider profiling activities.
EDUCATION AND EXPERIENCE:
Education Required:
· BA/BS degree (or equivalent experience)
Years and Type of Experience Required: Required:
· 5 Years of managed care experience and at least one year of leadership/management experience.
· 2 Years of provider relations experience with a preferred focus on behavioral health providers.
Specific Technical Skills Required:
· Proficiency with Microsoft computer applications including Outlook, Word, and Excel.
· Knowledge of provider reimbursement methodologies, claims processing, billing practices, and fee schedules.
· Strong telephonic and customer service skills.
· Effective presentation skills.
Certifications or Licensures Required:
· Must possess a valid driver's license.
Other Required:
· Knowledge of healthcare terminology
· Prior experience successfully managing people and projects
· Ability to gain team support and motivate team to action
· Excellent oral and written communication skills
· Excellent problem solving skills
· Ability to handle multiple tasks in a fast-paced environment.
· Appreciation of cultural diversity and sensitivity toward target population.
SCOPE INFORMATION
# Direct Reports: 1-8
# Indirect Reports:
Budgetary $ Responsibility:
PHYSICAL REQUIREMENTS
· Must be able to operate a computer.
· Must be able to operate a telephone.
· Must be able to travel locally.
· Must be able to operate a motor vehicle.
· Must be able to conduct and participate in meetings.
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.
Mgr Provider Relations-Behavioral Health
Job ID:
10551
Location: Nashville, TN
Full/Part Time:
Full-Time
Regular/Temporary:
Regular
JOB SUMMARY:
Responsible for daily management and coaching of Provider Services Team. Manages the functions relating to provider servicing, provider education and network development as appropriate in each Plan. Represents the Provider Relations Department at management meetings and interacts with management and staff of other departments as necessary.
PRIMARY RESPONSIBILITIES:
1. Manages the Provider Services Team, including Provider Relations Representatives and Research Specialist(s) and other Provider associates as assigned in the Plan.
2. Monitors team activities to assure that staff meets performance standards and is operating effectively and efficiently.
3. Produces weekly/monthly/quarterly reports via Sales force CRM (or appropriate software per Plan) and reports on departmental metrics.
4. Responsible for handling escalated claims/operational issues and taking action to assure timely resolution of provider issues.
5. Evaluates the provider network to ensure appropriate access for membership and develops/executes recruitment plans.
6. Monitors staff workloads and makes recommendations on distribution of work.
7. Provides coaching and training to direct reports.
8. Recommends and/or drafts provider communications relative to health plan policies and procedures.
9. Oversees provider education activities including development of presentations for orientations and education.
10. Promotes positive relationships with the provider community and other AMERIGROUP departments.
11. Supports earnings improvement initiatives.
12. Manages the site visit process as part of provider credentialing.
13. Oversees provider marketing activities.
14. Interfaces with all other departments to ensure appropriate configuration of contracts, reimbursement rates, and benefits, and to address claims and operational issues.
15. Participates in standing meetings as necessary.
16. Ensures that inventory of provider communication materials is maintained.
17. Manages the provider complaint and Provider Relations databases.
18. Monitors provider complaints and makes recommendations to Directors and Vice President for addressing provider issues.
19. Develops and implements action plans regarding provider satisfaction results.
20. Leads provider profiling activities.
EDUCATION AND EXPERIENCE:
Education Required:
· BA/BS degree (or equivalent experience)
Years and Type of Experience Required: Required:
· 5 Years of managed care experience and at least one year of leadership/management experience.
· 2 Years of provider relations experience with a preferred focus on behavioral health providers.
Specific Technical Skills Required:
· Proficiency with Microsoft computer applications including Outlook, Word, and Excel.
· Knowledge of provider reimbursement methodologies, claims processing, billing practices, and fee schedules.
· Strong telephonic and customer service skills.
· Effective presentation skills.
Certifications or Licensures Required:
· Must possess a valid driver's license.
Other Required:
· Knowledge of healthcare terminology
· Prior experience successfully managing people and projects
· Ability to gain team support and motivate team to action
· Excellent oral and written communication skills
· Excellent problem solving skills
· Ability to handle multiple tasks in a fast-paced environment.
· Appreciation of cultural diversity and sensitivity toward target population.
SCOPE INFORMATION
# Direct Reports: 1-8
# Indirect Reports:
Budgetary $ Responsibility:
PHYSICAL REQUIREMENTS
· Must be able to operate a computer.
· Must be able to operate a telephone.
· Must be able to travel locally.
· Must be able to operate a motor vehicle.
· Must be able to conduct and participate in meetings.
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.
Nearest Major Market: Nashville
Job Segments: Behavioral Health, Healthcare, Management
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