Provider Network Management Relations Executive

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 that will assist providers with objective and quantitative analysis of clinical quality performance measures. The Network Relations Service Executive is a professional accountable for proactively identifying issues, resolving disputes, and coordinating resolutions. Accountable for resolving complex problems, fielding general questions, and acting as a liaison between the provider of service and the health plan.

 

We're determined to take care of those working in healthcare.

Presbyterian is dedicated to improving people's lives - the lives of our patients and the lives of our coworkers. We're a locally owned and operated, which encourages supportive leadership that empowers employees. And we provide the opportunity to grow from entry-level to the most senior positions.

Why Join Us

• Full Time - Exempt: Yes
• Job is based at Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

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 different reimbursement methodologies i.e. capitation, DRG, Relative Value Systems, etc. 

• 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

• 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 provider 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 PIF s 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.

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 $37.58/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.