Manager Provider Services

Presbyterian is seeking a Manager - Provider Network Operations.

 

The person in this position will ensure the integrity of provider service, contracting, development of new networks. Build and maintain strong relationships with providers to foster collaboration and improve communication. Educates providers with current and new protocols, policies, procedures. Provides leadership to the department staff whose focus is education, support, engagement, fostering relationships while recruiting providers. Acts as a key resource in mentoring and education of staff. Responsible for identifying issues, resolving and coordinating resolution of complex disputes or issues. Contributes to the overall optimization of the provider network, ensuring adequate access and coverage for members.

 

Will manage and coordinate assignments and work productivity of supervised staff. Provides leadership and assistance to Supervisor, Trainer, Provider Executives, Provider Associates of Provider Network Operations. Provides direction and support for ensuring successful execution of contract compliance with Presbyterian Health Plan policy as well as compliance with applicable Medicare, Medicaid, third-party guidelines. Executes Presbyterian Health Plan’s network development strategies and initiatives.

• This is a Full Time position - Exempt: Yes
• Job is based at Rev Hugh Cooper Admin Center
• Work hours: Days

The ideal candidate will have:

• LTSS/Provider Services experience

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• Bachelors degree in business administration, or related health care field, 6 years of additional experience can be substituted in lieu of degree.
• Three years experience in provider relations, provider contracting, claims processing, correct coding, and customer service in a managed care organization.
• Four years of application specific experience.
• Two years management experience preferred.
• Requires effective coaching, counseling, and conflict management skills.
• Must be able to work collaboratively with other employees and the ability to multi-task.
• Demonstrated ability to sustain quality standards.
• Demonstrated ability to communicate in verbal and written form with peers, subordinates and the public, including physicians, physician office staff and staff.
• Ability to handle fluctuating workloads, conflicting priorities, and concurrent activities.
• Regional travel is required to meet with providers for purposes of recruitment, re-contracting, provider education, and/or attendance for any provider related functions.

• Manages and oversees all aspects of Provider Network Operations as is necessary to accomplish:
  a) Establishing and maintaining strong relationships with the provider community.
  b) Ensuring access to quality health care for health plan beneficiaries.
  c) Meeting enterprise goals of improving affordability and fiscal sustainability.
  d)Meeting health plan standards regarding operational administration.
• Oversee the daily operations of a healthcare provider network, ensuring smooth and compliant operations.
• Facilitate positive relationships with providers, addressing their questions, concerns, and providing support.
• Resolves complex provider contracts and reimbursement issues. Research problems and negotiate with internal/external partners/customers to resolve highly complex and/or escalated and sensitive issues. Identifies necessity for additional escalation and communicates issues effectively to senior leadership.
• Oversee compliance, oversight, and reporting of monthly departmental key indicators.

About Presbyterian Healthcare Services
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 to earn gift cards and other incentives.

As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships. Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

USD $52.95/Hr.

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.