Provider Relations Manager
Company: Elderwood Health Plan
Location: Tonawanda
Posted on: August 3, 2022
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Job Description:
Join Our Team: Make a difference in the lives of others. Join
our team today! Overview:Elderwood Health Plan has an exciting and
rewarding opportunity for Provider Relations Manager.The Provider
Relations Manager is responsible for managing the day-to-day
activities of the provider relations department and staff.
Responsible for assisting with departmental activities related to
provider satisfaction, education, and communication. This position
is also responsible for provider network recruiting and contract
management activities in its six service counties. Ensures the
department and staff remain current in all aspects of Federal and
State rules, regulations, policies and procedures and creates or
modifies departmental policies to reflect changes. Ensures
department achieves annual goals and objectives. The Provider
Relations Manager may be required to travel for meetings with a
variety of provider groups; including but not limited to,
in-network providers. Will be responsible for monitoring provider
network adequacy, contracting, pnds accuracy and provider
relationship management.$31.00-$38.00 starting range based on
experience and educationEmployee Perks!: 401K Retirement Plan with
Company Match, Free On-Site Parking, Generous PTO & holiday
package, Life Insurance, Medical, Dental, and Vision insurance,
Point-earning employee reward program: redeem for prizes!,
Substantial employee referral program Responsibilities:Essential
Job FunctionsOver sees all aspects, implementation and provisions
of contracting and provider relations.Direct oversight of Provider
Relations Staff.Continuously manage a broad base of providers and
services.Use Excel and TruChart to track and report on provider
network as needed.Conduct quarterly reviews of contract
relationships and resolve problems to build and maintain positive
partnerships.Works with finance and compliance officer to initiate
provider audits.Partner with care management team to identify and
measure methods to improve process and workflow.Provide assistance
regarding education, contract questions and non-routine
claims.Manage provider network relationships through contract
negotiations, network development to prevent network deficiencies,
and ensure credentialing policies are followed and
maintained.Serving as a knowledge and resource expert regarding the
most complex provider issues impacting provider satisfaction.Works
with Executive Director to ensures compliance with all state and
federal regulations regarding provider contracting.Works with the
Executive Director, Director of Clinical Operations, Director of
Business Development, Director of Finance and other management
staff to provide effective leadership and vision. Creates and
generates reports to keep management informed of the current and
anticipated network adequacy.Supervise and coach provider relations
staff.Perform other related duties and responsibilities as
directed.Collaborate with other professionals within the
organization and in the community.Demonstrate a clear understanding
of EHP mission, purpose, and philosophy.Adhere to ethical business
practices by striving to perform in a manner that conforms to the
highest standards of ethical behavior, integrity, and honesty.Take
initiative and responsibility for decisions as an individual and as
a company.Participate in the ongoing development of competencies,
capabilities, technology, and the resources needed to achieve high
standards of efficiency and effectiveness.Approach everything with
the passion and desire to meet the highest standards.Treat
employees, members, providers and business partners with respect.
Foster teamwork by trusting and supporting each other while
encouraging collaboration at all levels of the organization.
Embrace diversity and demonstrate the ability to work
together.Maintain confidentiality of all agency and member related
information. Protect member rights as defined in the Member Bill of
Rights.Maintain proper attendance and punctuality to ensure that
the department is operated in an efficient and cost-effective
manner.Adhere to departmental and agency dress codes.Utilize
material, equipment, and time in a safe, beneficial, and
cost-effective manner.On an ongoing basis identify and coordinate
contact with new providers.Other duties as required by
management.Base salary starting at (note: salary increases with
experience):: USD $31.00/Hr. Qualifications:Bachelor s Degree in a
related field requiredFour (4) years experience working in a
managed care environment, serving in a provider relations, contract
management or equivalent role.Minimum of one (1) year experience
working with an infirmed or elderly population.Must be in good
standing with the Medicare and Medicaid programs.Bilingual skills
are preferred, but not required.Must provide own transportation and
possess a clean driving record.EOE Statement: WE ARE AN EQUAL
OPPORTUNITY EMPLOYER. Applicants and employees are considered for
positions and are evaluated without regard to mental or physical
disability, race, color, religion, gender, national origin, age,
genetic information, military or veteran status, sexual
orientation, marital status or any other protected Federal,
State/Province or Local status unrelated to the performance of the
work involved.
Keywords: Elderwood Health Plan, Tonawanda , Provider Relations Manager, Executive , Tonawanda, New York
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