Provider Network Operations Leader

Presbyterian Healthcare Services; Albuquerque (NM); Presencial; USD 76 000 - 129 000; Tempo integral

Resumo da oferta

Presbyterian Healthcare Services in Albuquerque, NM seeks a Manager of Provider Network Operations to ensure the integrity of provider service, contracting, and network development.

You will lead a team, recruit providers, oversee contracts, and ensure compliance with federal and state guidelines while advancing PHP strategies. This is a full-time, days shift role supporting improved access and affordability for members.

Qualificações

• Bachelor’s degree in business administration or healthcare field; substitution allowed with 6 years of additional relevant experience.
• At least 3 years in provider relations, provider contracting, claims processing, correct coding, and customer service within a managed care organization.
• Four years of application-specific experience.
• Two years of management experience preferred.
• Requires effective coaching, counseling, and conflict management skills.
• Must work collaboratively, multi-task, and sustain quality standards.
• Regional travel is required to meet providers for recruitment, re-contracting, and education.

Responsabilidades

• Oversee all aspects of Provider Network Operations to establish and maintain strong relationships with the provider community, and ensure access to quality health care for members.
• Manage daily operations to ensure smooth, compliant performance and achievement of enterprise goals.
• Address provider questions, concerns, and provide timely support; negotiate and resolve issues with internal/external partners.
• Resolves complex provider contracts and reimbursement issues and escalates issues to senior leadership as needed.
• Oversee compliance, oversight, and reporting of monthly departmental indicators and audits of workflows.
• Review contracts with providers to ensure compliance with organizational policies and regulations.
• Develop and maintain a robust provider network, including recruiting and onboarding new providers.
• Ensure all network activities comply with relevant federal, state, and organizational regulations.
• Provide direction and support to team members and ensure adherence to department policies.
• Act as a point of contact for solution delivery, monitoring performance and removing barriers to success.

Conhecimentos

Provider relations

Provider contracting

Claims processing

Formação académica

Bachelor's degree in business administration or health care field

Descrição da oferta de emprego

Presbyterian Healthcare Services in Albuquerque, NM seeks a Manager of Provider Network Operations to ensure the integrity of provider service, contracting, and network development.

You will lead a team, recruit providers, oversee contracts, and ensure compliance with federal and state guidelines while advancing PHP strategies. This is a full-time, days shift role supporting improved access and affordability for members.