Kintegra Health
STLC Provider Relations Manager
Kintegra Health, Newton, North Carolina, United States, 28658
Job Description
Job Description
Job Title : Provider Relations Manager FLSA Status : Exempt Salary Range:
See Pay Scale
Job Summary: The Provider Relations Manager presents an extraordinary opportunity for a mission-driven leader to play an integral role in establishing and supporting the Senior TLC Contracted Provider Network in the Senior TLC Gastonia, Shelby and Hickory service areas. This position reports directly to the Director of Finance. Specifications
Education : Bachelor's, or Master's in a related field (e.g., business/MBA, accounting, finance/MS, economics, math, healthcare
administration/MHA,
etc.) preferred, but not required. Experience : At least 1 years experience working with the frail elderly population. 2+ years of related experience in a similar role preferred. Number and Type of Employees Supervised (optional) : None Licensure, Registry or Certification Required : CPA preferred but not required. Special Training : Passion and mission orientation for serving high-risk seniors and frail older adults. Strong understanding of health plan and health care provider contracting & oversight, as well as financial funds flows & regulatory requirements, ideally in PACE &/or Medicare. Thrives in a relatively undefined, "zero to one" environment—unafraid to drive a wide-ranging set of projects, processes, and deliverables. Ability to work independently with relatively little direction and knows how and when to escalate effectively. Proficient in both Microsoft Excel and PowerPoint. Meets a standardized set of competencies for the specific position description established by Senior TLC, Inc. and approved by CMS before working independently. Immunizations:
Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact Ages of Patients Rendered Care: Neonate/Infant Early Childhood Adolescent Adult Geriatric All Age Groups Key Responsibilities : (*denotes an age-related skill or task) · Leads provider network administration, including strategic support for negotiations, managing Senior TLC’s catalog of contracts, properly loading all contracts into required systems/vendors, and managing the provider manual. · Assists with resolving Contracted Provider concerns in collaboration with the Finance Director and Medical Director. · Develops and maintains effective monitoring of contracts and required regulatory protocols. · Manages and provides oversight to selected other external vendors related to any Health Plan Operation functions, ensuring quality and adherence to protocols. · Maintains a list of all contracted providers and distributes annually to participants. When there are changes in the interim in the panel of contracted providers, publishes as part of Senior TLC's quarterly newsletter. · In collaboration with the Finance Director, reviews all contracts to ensure each contract is in compliance with the federal contract requirements and presented to the Senior TLC Management. · Annually, requests credentialing documentation, as specified for each provider type. Sends a request notification to all providers on October 1st with the expectation that all requested information is sent to STLC by December 1st. Sends notification letters to contracted providers who have delinquent credentials starting December 1st as described in the Contracted Services Policy and Procedure - IV. Notification of Delinquent Contracts and/or Credentials. · If any credentialing documents that have not been signed and/or received by Senior TLC on December 1st, then notifies key staff as listed in the Contracted Services Policy and Procedure. · Oversees contracts of Personal
Care/Homemaker/Chore
Provider/Skilled Home Care contracting, Transportation contracting and Skilled Nursing Home and Assisted Living Providers as required by the Contracted Services Policy and Procedure. · Assists the company in ad-hoc special projects, including fundraising, collaborations with external partners, vendor contracting, and other operating model decisions. · Continuously seeks improvements to processes and systems across functions as the size and complexity of our business grows. · Communicates confidently and persuasively to all audiences, including external stakeholders. · Supports Senior TLC’s mission to encourage and support the quality of life of seniors wishing to continue living in the community; its vision to be the preferred provider of individualized care for seniors in the community; and its values of respect, integrity, accountability, compatible goals, and compassionate care. · Other duties as assigned.
Job Description
Job Title : Provider Relations Manager FLSA Status : Exempt Salary Range:
See Pay Scale
Job Summary: The Provider Relations Manager presents an extraordinary opportunity for a mission-driven leader to play an integral role in establishing and supporting the Senior TLC Contracted Provider Network in the Senior TLC Gastonia, Shelby and Hickory service areas. This position reports directly to the Director of Finance. Specifications
Education : Bachelor's, or Master's in a related field (e.g., business/MBA, accounting, finance/MS, economics, math, healthcare
administration/MHA,
etc.) preferred, but not required. Experience : At least 1 years experience working with the frail elderly population. 2+ years of related experience in a similar role preferred. Number and Type of Employees Supervised (optional) : None Licensure, Registry or Certification Required : CPA preferred but not required. Special Training : Passion and mission orientation for serving high-risk seniors and frail older adults. Strong understanding of health plan and health care provider contracting & oversight, as well as financial funds flows & regulatory requirements, ideally in PACE &/or Medicare. Thrives in a relatively undefined, "zero to one" environment—unafraid to drive a wide-ranging set of projects, processes, and deliverables. Ability to work independently with relatively little direction and knows how and when to escalate effectively. Proficient in both Microsoft Excel and PowerPoint. Meets a standardized set of competencies for the specific position description established by Senior TLC, Inc. and approved by CMS before working independently. Immunizations:
Be medically cleared for communicable diseases and have all immunizations up to date before engaging in direct participant contact Ages of Patients Rendered Care: Neonate/Infant Early Childhood Adolescent Adult Geriatric All Age Groups Key Responsibilities : (*denotes an age-related skill or task) · Leads provider network administration, including strategic support for negotiations, managing Senior TLC’s catalog of contracts, properly loading all contracts into required systems/vendors, and managing the provider manual. · Assists with resolving Contracted Provider concerns in collaboration with the Finance Director and Medical Director. · Develops and maintains effective monitoring of contracts and required regulatory protocols. · Manages and provides oversight to selected other external vendors related to any Health Plan Operation functions, ensuring quality and adherence to protocols. · Maintains a list of all contracted providers and distributes annually to participants. When there are changes in the interim in the panel of contracted providers, publishes as part of Senior TLC's quarterly newsletter. · In collaboration with the Finance Director, reviews all contracts to ensure each contract is in compliance with the federal contract requirements and presented to the Senior TLC Management. · Annually, requests credentialing documentation, as specified for each provider type. Sends a request notification to all providers on October 1st with the expectation that all requested information is sent to STLC by December 1st. Sends notification letters to contracted providers who have delinquent credentials starting December 1st as described in the Contracted Services Policy and Procedure - IV. Notification of Delinquent Contracts and/or Credentials. · If any credentialing documents that have not been signed and/or received by Senior TLC on December 1st, then notifies key staff as listed in the Contracted Services Policy and Procedure. · Oversees contracts of Personal
Care/Homemaker/Chore
Provider/Skilled Home Care contracting, Transportation contracting and Skilled Nursing Home and Assisted Living Providers as required by the Contracted Services Policy and Procedure. · Assists the company in ad-hoc special projects, including fundraising, collaborations with external partners, vendor contracting, and other operating model decisions. · Continuously seeks improvements to processes and systems across functions as the size and complexity of our business grows. · Communicates confidently and persuasively to all audiences, including external stakeholders. · Supports Senior TLC’s mission to encourage and support the quality of life of seniors wishing to continue living in the community; its vision to be the preferred provider of individualized care for seniors in the community; and its values of respect, integrity, accountability, compatible goals, and compassionate care. · Other duties as assigned.