What are the responsibilities and job description for the Manager of Provider Relations position at Provider Partners Health Plan?
Provider Partners Health Plan (Provider Partners) is a Medicare Advantage HMO plan for individuals enrolled in Medicare who reside in long-term care facilities. Provider Partners is truly something new – a Special Needs Plan run by a team of highly experienced long-term care providers that work with physicians, hospitals, and other providers to improve the quality of care and outcomes for its members. Patients and their families appreciate the extra, personalized touch offered in facilitating communication and care delivery among all the providers involved in their care.
Be one of the first applicants, read the complete overview of the role below, then send your application for consideration.
Provider Partners offers a service product that greatly improves the life of others. We are searching for a results-oriented individual, with a proven track record, who is passionate about our mission and can generate positive outcomes based on that mission. If this is you, come be part of our elite team as a Manager of Provider Relations. Reporting to the Director of Provider Relations, the Manager of Provider Relations will play a key role in providing operational support to the provider management team.
Primary Role and Responsibilities :
- Assist providers with problem resolution and claims issues.
- Assist with member claims issues.
- Input of providers into Salesforce.
- Ancillary and PCP education and re-education.
- Responses to member inquiries.
- Claims utilization reporting through operations.
- Facility Profile execution for new and existing partners.
- Upload new agreements into Salesforce.
- Consolidate provider rosters as needed.
- Ensure that Beacon has updated provider information.
- Dissemination of Pre-Check Run to Provider Relations Team.
- Reach out to contract new providers.
- Assist with plan growth and contracting.
- Train all new employees.
- Assist with department policy and procedure annual maintenance.
- Maintain Training Guides / Develop Training Guides.
- Ensure that all agreements are executed and sent to the correct team member.
- Review and assign HAX tickets weekly to the Provider Relations Team.
- Management of credentialing reports.
- Management of provider reports.
- Individual bi-weekly team member one on ones.
- Weekly one on ones with the Director of Provider Relations.
- Maintain the Provider Network SharePoint by ensuring the documents are current and up to date.
- Supply coverage (or delegate based on bandwidth) for scheduled and unscheduled teammate work absences.
- Attendance to high level adequacy meetings as needed.
- Oversee the management of data entry employees.
- Other job duties as needed.
Qualifications :
J-18808-Ljbffr
