Presbyterian Healthcare Services
Provider Network Management Relations Executive
Presbyterian Healthcare Services, Albuquerque, New Mexico, United States, 87101
Overview
Presbyterian Healthcare is seeking a
Provider Network Management Relations Executive . Provides oversight of network strategies and relationship development activities for assigned providers, including individualized planning, training and development of providers to align with Presbyterian’s clinical quality initiatives. Will provide the framework for physician/provider performance reporting to assist providers with objective and quantitative analysis of clinical quality performance measures. The Network Relations Service Executive is accountable for proactively identifying issues, resolving disputes, and coordinating resolutions. Acts as a liaison between the provider of service and the health plan. Why join Presbyterian? We are dedicated to taking care of those working in healthcare, improving people’s lives, and offering opportunities for career growth from entry-level to senior positions. Details
Job type: Full Time - Exempt Location: Rev Hugh Cooper Admin Center, Albuquerque, NM Minimum Offer: USD $24.62/hour Maximum Offer: USD $37.58/hour Ideal Candidate
Three years experience in provider relations, provider contracting, claims processing, or customer service in a healthcare organization. Strong working knowledge of risk sharing programs and reimbursement methodologies (e.g., capitation, DRG, Relative Value Systems). Excellent verbal and written communication, presentation, interpersonal, and negotiation skills. Strong facilitation, organizational, and computer skills. Qualifications
Three years experience in provider relations, provider contracting, claims processing, or customer service in a healthcare organization. Knowledge of risk sharing programs and reimbursement methodologies (capitation, DRG, Relative Value Systems, etc.). Strong communication and interpersonal skills with ability to interface with providers. Proficiency in facilitation, organization, and computing. Education: Essential — High School Diploma or GED Responsibilities
Collaborates and maintains relationships with providers and staff throughout Presbyterian to ensure an exceptional provider experience. Develops and maintains cooperative working relationships between Presbyterian Health Plan, institutional providers, and individual providers. Provides education on quality initiatives, managed care, capitation, products, policies and procedures, reimbursement issues, and the referral/authorization process. Ensures provider data integrity and accuracy by timely completion and validation of provider directory data. Responsible for post-payment validation of assigned providers to ensure payment accuracy to contracts and fee schedules. Resolves provider issues—claims, health services, finance, etc. Supports professional development of Network Relations Service Associates. Supports Network Contracting strategies to preserve a robust provider network. Serves as primary liaison between providers and the health plan. Maintains knowledge of health plan reimbursement methodologies. Conducts provider visits based on departmental goals (50–65% field contact). Promotes department initiatives and collaborates to achieve business objectives. Provides consulting and educational support to providers regarding healthcare access and navigation of the system to improve provider satisfaction. Participates in process improvement and cross-functional teams and business initiatives. Follows confidentiality requirements and demonstrates inclusive, collaborative problem-solving. Benefits & About
About Presbyterian Healthcare Services
Presbyterian offers a comprehensive benefits package including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits. The Employee Wellness Rewards Program encourages health-promoting activities with incentives. Presbyterian is a mission-driven, not-for-profit organization with a wide network across New Mexico, employing thousands of staff to serve health plan members. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke-free campuses.
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Presbyterian Healthcare is seeking a
Provider Network Management Relations Executive . Provides oversight of network strategies and relationship development activities for assigned providers, including individualized planning, training and development of providers to align with Presbyterian’s clinical quality initiatives. Will provide the framework for physician/provider performance reporting to assist providers with objective and quantitative analysis of clinical quality performance measures. The Network Relations Service Executive is accountable for proactively identifying issues, resolving disputes, and coordinating resolutions. Acts as a liaison between the provider of service and the health plan. Why join Presbyterian? We are dedicated to taking care of those working in healthcare, improving people’s lives, and offering opportunities for career growth from entry-level to senior positions. Details
Job type: Full Time - Exempt Location: Rev Hugh Cooper Admin Center, Albuquerque, NM Minimum Offer: USD $24.62/hour Maximum Offer: USD $37.58/hour Ideal Candidate
Three years experience in provider relations, provider contracting, claims processing, or customer service in a healthcare organization. Strong working knowledge of risk sharing programs and reimbursement methodologies (e.g., capitation, DRG, Relative Value Systems). Excellent verbal and written communication, presentation, interpersonal, and negotiation skills. Strong facilitation, organizational, and computer skills. Qualifications
Three years experience in provider relations, provider contracting, claims processing, or customer service in a healthcare organization. Knowledge of risk sharing programs and reimbursement methodologies (capitation, DRG, Relative Value Systems, etc.). Strong communication and interpersonal skills with ability to interface with providers. Proficiency in facilitation, organization, and computing. Education: Essential — High School Diploma or GED Responsibilities
Collaborates and maintains relationships with providers and staff throughout Presbyterian to ensure an exceptional provider experience. Develops and maintains cooperative working relationships between Presbyterian Health Plan, institutional providers, and individual providers. Provides education on quality initiatives, managed care, capitation, products, policies and procedures, reimbursement issues, and the referral/authorization process. Ensures provider data integrity and accuracy by timely completion and validation of provider directory data. Responsible for post-payment validation of assigned providers to ensure payment accuracy to contracts and fee schedules. Resolves provider issues—claims, health services, finance, etc. Supports professional development of Network Relations Service Associates. Supports Network Contracting strategies to preserve a robust provider network. Serves as primary liaison between providers and the health plan. Maintains knowledge of health plan reimbursement methodologies. Conducts provider visits based on departmental goals (50–65% field contact). Promotes department initiatives and collaborates to achieve business objectives. Provides consulting and educational support to providers regarding healthcare access and navigation of the system to improve provider satisfaction. Participates in process improvement and cross-functional teams and business initiatives. Follows confidentiality requirements and demonstrates inclusive, collaborative problem-solving. Benefits & About
About Presbyterian Healthcare Services
Presbyterian offers a comprehensive benefits package including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits. The Employee Wellness Rewards Program encourages health-promoting activities with incentives. Presbyterian is a mission-driven, not-for-profit organization with a wide network across New Mexico, employing thousands of staff to serve health plan members. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke-free campuses.
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