2 Provider Network Manager-Physical Health Enrollment Jobs in Albemarle, NC
SORT BY
P
P
Provider Network Manager-Physical Health Enrollment
$97k-129k (estimate)
Full Time | Ambulatory Healthcare Services
1 Month Ago
Partners Health Management is Hiring a Provider Network Manager-Physical Health Enrollment Near Albemarle, NC
Competitive Compensation & Benefits Package! Position eligible for –
Location: Remote/Hybrid option; Available for any of the Partners locations in NC
Projected Hiring Range: Depending on Experience
Closing Date : Open Until Filled Primary Purpose of Position: The Provider Network Manager - Physical Health Enrollment is responsible for ensuring that the providers contracted with partners through an external vendor, physical health, pharmacy, HOP, NEMT, etc. are set up accurately in the provider information system for state reporting, claims payment, and directories. Responsible for multiple state deliverables, network reporting and directories as well as claims payment resolution as it relates to provider set up and validation.
Role And Responsibilities
Must have ability to travel as needed to perform job duties. NC Residency is required.
Education/Experience Preferred: Master’s Degree in mental health, public health, social work, psychology, education, sociology, business or public administration and five (5) years of experience in a community, business, or governmental program in health-related fields, social work or education including experience in network operations, provider relations and management experience. Three (3) years of supervisory, consultative, or administrative experience. NC Residency is required.
Licensure/Certification Requirements: None
- Annual incentive bonus plan
- Medical, dental, and vision insurance with low deductible/low cost health plan
- Generous vacation and sick time accrual
- 12 paid holidays
- State Retirement (pension plan)
- 401(k) Plan with employer match
- Company paid life and disability insurance
- Wellness Programs
Location: Remote/Hybrid option; Available for any of the Partners locations in NC
Projected Hiring Range: Depending on Experience
Closing Date : Open Until Filled Primary Purpose of Position: The Provider Network Manager - Physical Health Enrollment is responsible for ensuring that the providers contracted with partners through an external vendor, physical health, pharmacy, HOP, NEMT, etc. are set up accurately in the provider information system for state reporting, claims payment, and directories. Responsible for multiple state deliverables, network reporting and directories as well as claims payment resolution as it relates to provider set up and validation.
Role And Responsibilities
- Responsible for the enrollment of provider profile information into the Alpha Plus system for the purpose of claims processing, authorization processing and maintaining a provider directory in compliance with national accreditation standards. Ensures Enrollment staff consistently meet timeliness expectations for data entry and provide excellent customer service to the providers as it relates to their enrollment status.
- Responsible for ensuring that providers are properly enrolled in NC Tracks prior to enrolling them into the Alpha Plus system.
- Assist in the completion of the annual capacity study in an effort to identify gaps in services and address the needs of the community.
- Responsible for the cultivation and development of provider choice through management of processes and development, implementation and maintenance of policies, procedures and protocols for reviewing/accepting new services and new providers in accordance with Best Practices within the Network including oversight and maintenance of the out of network contracting process for physical health providers working in collaboration with the Tailored Plan Physical Health partners.
- Contributing to ensuring adding processes and procedures for maintaining and updating the Provider Operations Manual; Participate in Provider Council meetings, Provider Orientation and Provider Forums; Responsible for creating provider bulletins and alerts as necessary.
- Attend provider Board meetings and other provider specific functions to educate and support providers with regard to Best Practices, Network requirements, needs and other issues of provider interest.
- Facilitate caucus groups regarding Mental Health, Developmental Disabilities or Substance Use as needed or requested.
- Perform special projects/participate on ad hoc workgroups as requested by management.
- Develops and maintains policies and procedures related to provider set up and data validation.
- Provide support to internal and external stakeholders to resolve provider data issues
- Provide oversight and supervision to the team tasked with researching and effectively responding to provider data related issues
- Provide oversight and supervision to the team tasked with tracking, updating and auditing provider data
- Work with other departments on cross functional tasks and projects
- Collaborate with health plan regarding compliance with provider set up and validation for all network requirements through data review, monitoring and collaboration.
- Manage and foster solid collaborative relationships with external stakeholders and internal department leaders to develop the innovation and recommendations for next steps.
- Assess and manage risk throughout all aspects of the solution design and development and escalates as needed.
- Provides oversight and supervision to the team tasked with Interpreting audit results, identifying trends/patterns that impact service/system quality, and then implementing interventions aimed at addressing these trends/patterns with the outcome of services delivery to consumers at the highest degree of quality cross functional team activities;
- Manage enrollment and maintenance specialists charged with performing day to day duties of assuring providers are set up accurately in the provider information and provider portal system
- Provide oversight and supervision to the team tasked with providing appropriate reports and statistical data to other department designees for review, follow-up and resolution
- Manage the team tasked with performing detailed analysis on multiple projects, recommending potential business solutions and ensuring successful implementations, including improvements and revisions to business processes and requirements
- Serve as the subject matter expert on provider set up and validation to ensure operational performance
- Resolve issues and identify opportunities for process redesign and improvement
- Considerable knowledge of the laws, regulations and policies that govern the program
- Exceptional interpersonal and communication skills
- Strong problem solving, negotiation, arbitration, and conflict resolution skills
- Excellent computer skills and proficiency in Microsoft Office products (such as Word, Excel, Outlook, and PowerPoint
- Demonstrated ability to verify documents for accuracy and completeness; to understand and apply laws, rules and regulations to various situations; to apply regulations and policies for maintenance of consumer medical records, personnel records, and facility licensure requirements
- Ability to make prompt independent decisions based upon relevant facts
- Ability to establish rapport and maintain effective working relationships
- Ability to act with tact and diplomacy in all situations
- Ability to maintain strict confidentiality in all areas of work
- Must be able to work independently and use good judgement in making critical decisions that impact service availability inside the Partners network;
- Attention to detail and adherence to strict timelines is essential to the success of this position
Must have ability to travel as needed to perform job duties. NC Residency is required.
Education/Experience Preferred: Master’s Degree in mental health, public health, social work, psychology, education, sociology, business or public administration and five (5) years of experience in a community, business, or governmental program in health-related fields, social work or education including experience in network operations, provider relations and management experience. Three (3) years of supervisory, consultative, or administrative experience. NC Residency is required.
Licensure/Certification Requirements: None
Job Summary
JOB TYPE
Full Time
INDUSTRY
Ambulatory Healthcare Services
SALARY
$97k-129k (estimate)
POST DATE
05/23/2024
EXPIRATION DATE
07/13/2024
WEBSITE
partnersbhm.org
HEADQUARTERS
GASTONIA, NC
SIZE
200 - 500
FOUNDED
2012
CEO
RHETT MELTON
REVENUE
$10M - $50M
INDUSTRY
Ambulatory Healthcare Services
Related Companies
About Partners Health Management
Partners Health Management is the local manager of mental health, substance use disorder, and intellectual and developmental disabilities treatment available through Medicaid, state, and county funding. We contract with care providers to ensure that treatment options are available for eligible residents of Burke, Catawba, Cleveland, Gaston, Iredell, Lincoln, Rutherford, Surry, and Yadkin counties. Our Crisis Line is available all day, every day at 1-888-235-HOPE (4673). Learn more about us at www.PartnersBHM.org.
Show more
Similar Jobs
Popular Articles
Top 10 Things to Avoid Putting on a Job Application
Read Article
How to Describe Your Education in a Resume
Read Article
How to Write a Memorable Cover Letter in 5 Ways
Read Article
4 Personal Finance Tips to Make During Job Transition
Read Article
4 Best Camera Setups for Interview
Read Article
Keeping a Job Search Journal: 9 Types of Journaling You Can Do
Read Article
