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Manager, Network and Provider Services

Job Posting
Manager, Network and Provider Services
Job Details
Job Type

Full-time

Greensboro, NC • Operations
Description
Job Summary

The Manager, Network and Provider Services is responsible for managing the operational functions of HealthTeam Advantage’s (HTA) provider networks. This includes directly managing the Plan’s recruitment, contracting, credentialing, provider services, and provider data management functions.

Major Work Activities

Lead and negotiate provider, facility, and ancillary contracts and amendments to ensure a high-quality network that meets all relevant adequacy standards and helps ensure appropriate reimbursement methodologies are in place (performance incentives, capitation, per diems, creative reimbursement, etc.) to maximize quality and cost savings
Manages the development and execution of provider network business plans, strategies, and goals including business development and retention
Works cross-functionally to execute network strategies and align provider contracting efforts with the goals and objectives of the organization; monitors local, regional, and national market trends relative to function and integrates innovations as appropriate
Fully administers the credentialing program, ensuring timely and accurate provider and facility credentialing and re-credentialing.
Provide direction that creates and maintains credentialing policies and procedures which ensure compliance with organizational, government, regulatory, and accreditation standards.
Ensures contracted providers maintain minimum clinical credentials, facility licenses, and insurance requirements; and participates as a member of the Credentialing Committee.
Ensures the Plan maintains complete and properly prepared files for credentialing and re-credentialing.
Oversee all activities related to the management of provider data, including continued reviews of adequacy and submission of HSD tables as required.
Ensure updates (adds, changes, and terminations) for new or existing provider records are made per Health Plan Service Level Agreements (SLAs)
Manage updates to and production of hard copy and online provider directories
Schedule monthly provider data verifications to ensure accuracy of provider demographic and accessibility information to maintain CMS requirements.
Conducts audits and recommends revisions to existing procedures and processes, and may establish new procedures as appropriate
Create and maintain KPIs, goals, and objectives for provider data management.
Responsible for systems implementation as necessary
Participates in testing and audit activities related to data integrity and accuracy.
Responsible for supporting, coordinating, and overseeing provider services as it relates to claims processing, provider education, provider orientations/onboarding, contracting and credentialing, and provider data management.
Directly oversees the Plan’s provider call center, and employees acting as an owner of overall team performance by actively monitoring work queues, call evaluations, and metrics
Develops provider engagement strategies and procedures to increase provider satisfaction
Develops and maintains provider onboarding process
Develop and implement complaint process to ensure timely and accurate resolution
Identify areas of opportunity and document workflows/processes to affect positive changes
Supports network by monitoring and communicating trends and issues that may affect relationships.
Builds effective teams by leading with influence, (both internally and externally) to achieve established goals and within established budgets.
Contribute to a culture of customer advocacy, continuous improvement, and exceptionally high standards
Establish and maintain a positive working relationship with shareholders, regulatory agencies, and vendors
Maintains a high level of professional standards with interactions, communications and
Performs other duties as assigned


Requirements
Requirements

Minimum Qualifications

Required Education

Bachelor’s Degree in business, or other healthcare-related field or five (5) or more years equivalent healthcare work experience

Required Licensure/Certification

Required Experience

Three (3) or more years working with provider contracting and credentialing.
Two (2) or more years of experience with provider data management.
One (1) year or more of Medicare Advantage provider relations and/or provider network management
Required Knowledge, Skills, and Abilities

Must possess a working knowledge of contract negotiations and provider payment methodologies.
Familiarity with network adequacy standards.
Federal and state credentialing requirements
Strong in the following competencies:
Negotiation
Decision Making/Judgment
Problem Solving/Analysis
Communication
Creativity/Innovation
Outstanding interpersonal skills including Active Listening, Social Perceptiveness, Speaking, and Critical Thinking Skills
Fair and focused leadership
Self-motivated with excellent follow-through
Ability to provide a team-oriented work environment that delivers a positive team culture
Preferred Education

Master’s degree in business or other healthcare-related fields

Preferred Experience

Experience working with regulatory agencies such as the Centers for Medicare & Medicaid Services
Experience leading/ coordinating projects
Preferred Knowledge, Skills, and Abilities

Knowledge of value-based contracting.
Knowledge of computer databases, including, but not limited to SQL.
Knowledge of provider practice and ancillary provider operations.
Knowledge of the local provider community.
Project Management

Time:  Full time
Salary:  Salary
Category:  Administration

Updated: 5/25/2022 9:30:47 AM

Job Contact:
Michael Abner
13364483122

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7800 McCloud Road
Greensboro, NC 27409

13364483122