Supervisor of Provider Systems

Overview

The Supervisor of Provider Systems will supervise the day-to-day operations of the Provider Relations (PR) Department functions involving provider data used for operations, reporting and claims processing. Provides supervision, support and guidance to the PR Systems staff. Monitors inventory and disseminates work based on timeliness standards and competing priorities.

Responsibilities

• Supervises the daily functions of PR department Systems staff.
• Monitors staff productivity, quality, accuracy and service delivery based on performancestandards. Ensures regulatory timeliness standards are met consistently.
• Monitors inventory control reports to ensure timeliness standards are being met. Assignsor reassigns work required to maintain service levels.
• Provides management with weekly updates on the inventory status and recommendedactions required to ensure daily functions are adequately addressed.
• Coaches staff to work with providers and internal departments to ensure providers areset-up accurately and resolve data discrepancies affecting claims payments and reporting.
• Meets monthly with direct report staff to provide performance feedback
• Ensures regulatory reports and provider directories meet compliance standards
• Oversees provider network reporting, responding to internal inquires for ad hoc reports.
• Develops, implements and oversees training plans for new hires and ensure trainingprogresses according to schedule. Ensure training guides and tools are developed and upto-date.
• Oversees the successful completion of ongoing training plans to ensure adequateredundancy for all functions.
• Supports staff development by identifying new training opportunities and shadowing atinterdepartmental meetings.
• Maintains updated desk procedures and other resource materials and oversee the timelycompletion of written procedures by staff as assigned.
• Interviews and participates in selection of PR staff that will directly report to supervisor.
• Writes and conducts staff performance evaluations.
• Acts as a liaison with internal PHC Departments to assist with resolving questionsrelating to provider data and system set-ups.
• Ensures the team conducts timely outreach to resolve data discrepancies and obtaininformation required to ensure reporting and claims are accurate.
• Supports PR with provider network reports and regulatory deliverables involvingprovider data.
• Participates in workgroups designed to improve accuracy or support regulatorydirectives.
• Attends internal and external meetings and participate in or recommends solutions toissues.
• Recommends process improvements designed to improve efficiency.
• Promotes a positive attitude, teamwork and fun in the workplace.
• Other duties as assigned.

Qualifications

Education and Experience

Bachelor’s degree in Healthcare, Business, or related field; andminimum three (3) years of experience in healthcare, provider data,credentialing, or provider systems; or equivalent combination ofeducation and experience. Previous supervisory experience a plus.

 

Special Skills, Licenses and Certifications

Working knowledge of business software applications. Knowledge ofmanaged care concepts, managed Medi-Cal, Network Standards,regulatory reporting and provider directories. Ability to implementMedi- Cal policies and procedures and All Plan Letters. Ability todemonstrate subject matter expertise in provider systems, data andcredentialing. Valid California driver’s license and proof of currentautomobile insurance compliant with PHC policy are required tooperate a vehicle and travel for company business.

 

Performance Based Competencies

Excellent oral and written communication skills. Excellent organizationskills with the ability to prioritize assignments, maintain accuraterecords, and meet deadlines. Ability to interpret and understandcomplex technical and regulatory requirements. Ability to use goodjudgment in making decisions within scope of authority and handlesensitive issues with tact and diplomacy.

Work Environment And Physical Demands

Ability to use a computer keyboard. More than 30% of work time isspent in front of a computer monitor. When required, ability to move,carry, or lift objects of varying size, weighing up to 35 lbs. Ability towork in a fast paced environment with frequent interruptions andmultiple competing deadlines.

 

All HealthPlan employees are expected to:

• Provide the highest possible level of service to clients;
• Promote teamwork and cooperative effort among employees;
• Maintain safe practices; and
• Abide by the HealthPlan’s policies and procedures as they may from time to time be updated.

HIRING RANGE:

 

 $93,690.86 - $117,113.58

 

IMPORTANT DISCLAIMER NOTICE

 

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform.  The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Salary : $93,691 - $117,114