Presbyterian Healthcare Services
Provider Network Management Relations Executive
Presbyterian Healthcare Services, Albuquerque, New Mexico, United States, 87101
Overview
Presbyterian Healthcare Services is seeking a
Provider Network Management Relations Executive . This role provides oversight of network strategies and relationship development with assigned providers, including individualized planning, training and development to align with Presbyterian’s clinical quality initiatives. The role supports provider performance reporting and quantitative analysis of clinical quality measures. Acts as a primary liaison between providers and the health plan, identifies issues, resolves disputes, and coordinates resolutions. Responsibilities
Collaborates and maintains relationships with providers and staff throughout Presbyterian to ensure an exceptional provider experience. Develops and maintains cooperative working relationships between PHP, institutional providers and individual providers. Provides education on quality initiatives, managed care, capitation, products, policies and procedures, reimbursement issues, referral/authorization process, etc. Responsible for ensuring provider data integrity and accuracy by ensuring PIFs are completed timely and accurately and through a comprehensive review and validation of provider directory data. Responsible for post payment validation of assigned providers to ensure accuracy of payment to the contract and corresponding fee schedules. Resolves provider issues - claims, health services, finance, etc. Stimulates and fosters professional development of the Network Relations Service Associates. Supports Network Contracting strategies in an effort to preserve a robust provider network. Serves as primary liaison between the provider and the health plan. Maintains a general knowledge of health plan reimbursement methodologies. Conducts provider visits based on established departmental goals, which will require 50-65% field contact. Engages and supports leadership and peers by promoting and participating in department initiatives and being accountable for achieving business objectives. Provides consulting and educational support to providers regarding appropriate health care access and navigation of the healthcare system to improve provider satisfaction. Participates in a value-added manner both individually and in a team environment, process improvement teams and business initiatives. Follows appropriate confidentiality requirements. Practices respecting and valuing the differences in each person and demonstrates an inclusive style that fosters dialogue for collaborative solutions in recommending healthcare resources. Qualifications
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 different reimbursement methodologies i.e. capitation, DRG, Relative Value Systems, etc. Must demonstrate strong verbal, written communication, and presentation skills with strong interpersonal and negotiations skills and ability to interface with providers. Must also possess strong facilitation, organizational, and personal computing skills. Education: Essential: High School Diploma or GED Benefits
Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits. The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities – like challenges, webinars, and screenings – with opportunities to earn gift cards and other incentives. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke-free campuses. Compensation
Base pay range:
$24.62/hr - $37.58/hr . Maximum Offer for this position is up to
$37.58/Hr . Compensation Disclaimer: The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.
#J-18808-Ljbffr
Presbyterian Healthcare Services is seeking a
Provider Network Management Relations Executive . This role provides oversight of network strategies and relationship development with assigned providers, including individualized planning, training and development to align with Presbyterian’s clinical quality initiatives. The role supports provider performance reporting and quantitative analysis of clinical quality measures. Acts as a primary liaison between providers and the health plan, identifies issues, resolves disputes, and coordinates resolutions. Responsibilities
Collaborates and maintains relationships with providers and staff throughout Presbyterian to ensure an exceptional provider experience. Develops and maintains cooperative working relationships between PHP, institutional providers and individual providers. Provides education on quality initiatives, managed care, capitation, products, policies and procedures, reimbursement issues, referral/authorization process, etc. Responsible for ensuring provider data integrity and accuracy by ensuring PIFs are completed timely and accurately and through a comprehensive review and validation of provider directory data. Responsible for post payment validation of assigned providers to ensure accuracy of payment to the contract and corresponding fee schedules. Resolves provider issues - claims, health services, finance, etc. Stimulates and fosters professional development of the Network Relations Service Associates. Supports Network Contracting strategies in an effort to preserve a robust provider network. Serves as primary liaison between the provider and the health plan. Maintains a general knowledge of health plan reimbursement methodologies. Conducts provider visits based on established departmental goals, which will require 50-65% field contact. Engages and supports leadership and peers by promoting and participating in department initiatives and being accountable for achieving business objectives. Provides consulting and educational support to providers regarding appropriate health care access and navigation of the healthcare system to improve provider satisfaction. Participates in a value-added manner both individually and in a team environment, process improvement teams and business initiatives. Follows appropriate confidentiality requirements. Practices respecting and valuing the differences in each person and demonstrates an inclusive style that fosters dialogue for collaborative solutions in recommending healthcare resources. Qualifications
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 different reimbursement methodologies i.e. capitation, DRG, Relative Value Systems, etc. Must demonstrate strong verbal, written communication, and presentation skills with strong interpersonal and negotiations skills and ability to interface with providers. Must also possess strong facilitation, organizational, and personal computing skills. Education: Essential: High School Diploma or GED Benefits
Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits. The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities – like challenges, webinars, and screenings – with opportunities to earn gift cards and other incentives. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke-free campuses. Compensation
Base pay range:
$24.62/hr - $37.58/hr . Maximum Offer for this position is up to
$37.58/Hr . Compensation Disclaimer: The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.
#J-18808-Ljbffr