Network / Provider Relations Manager
The Manager of Network Operations is instrumental to the Network Team in contributing to the strategic initiatives and development of Network operations development plan and growth. Compiles data, works closely with and contributes to the Network contracting and decision making processes for business development including but not limited to: GEO mapping, Provider Performance Measures, Financial performance of Network contracts, Regulatory requirements for all Health Choice Lines of Business. Work in collaboration cross departmentally within Health Choice, internal and external business partner and stakeholders in support of operational goals and objectives. Provides leadership and management for the Internal and External Provider Service Rep Teams.
Collects, analyzes, and interprets provider data as requested and required for department regulatory reporting. Establishes schedules to collect and interpret data. Provides ad hoc reporting as requested by department staff and health plan executives, querying data from Health Choice business operating systems and creating usable reports. Produces, sets up, and distributes provider blast fax communications and monitors for correctness, reporting and re-sending information that may fail. Works with Business Intelligence and/or Med/Econ in collaboration for specialized and specific data reporting requirements. Collects data for provider directory, provider web site for publication. Develops new reports and processes, identifies opportunities to streamline processes; use advance spreadsheet and database skills; provide recommendations on ways to make the provider data more efficient.
Health Choice exists to improve the health and well-being of the individuals we serve through our health plans, integrated delivery systems and managed care solutions. We strive to recruit and retain only the finest health care professionals with the highest levels of integrity, compassion and competency. If you are driven by your own personal commitment to these values and desire to work in a team-focused, collaborative and supportive environment - while still being valued for your individual strengths - Health Choice is the place for you.
Equal Opportunity Employer Minorities/Women/Veterans/Disabled
College degree (Bachelor's preferred) in MIS, Computer Science, Business or related field
Two (2) years experience managing teams
Medicaid and Medicare familiarity helpful
Healthcare payer knowledge helpful
Knowledge of HIPAA transactions
Knowledge of Medicare and Medicaid regulations and reporting requirements
Intimate knowledge of Health Choice operating systems, ED/MC functionality