Remote Provider Network Operations Lead

RPMGlobal; Southfield (MI); Hybrid; USD 65,000 - 90,000; Full time

Job summary

RPMGlobal seeks a Provider Network Operations Supervisor to oversee the daily activities of the Provider Network Operations team, ensuring performance, efficiency, and policy compliance. The role is fully remote for candidates located in Michigan, with monthly in-person meetings in Southfield as needed.

The position requires strong leadership, healthcare operations knowledge, and the ability to drive process improvements in a fast-paced environment.

Qualifications

• Associate degree required or equivalent combination of education and relevant work experience.
• 1 to 3 years of supervisory or leadership experience preferred.
• Experience in managed care or healthcare environment preferred.
• Knowledge of claims processing, coding, payment, and/or provider data operations strongly preferred.
• Familiarity with Medicaid reimbursement methodologies preferred.

Responsibilities

• Supervise, coach, and monitor staff performance to ensure quality and timely completion of work
• Support the Manager in implementing departmental initiatives and process improvements
• Ensure operational processes align with internal policies, contractual obligations, and service level agreements (SLAs)
• Oversee and support the resolution of provider inquiries and complaints, ensuring timely and effective outcomes
• Monitor provider data maintenance and/or claims-related activities, providing feedback and recommendations for improvement
• Research and resolve complex claims issues and operational discrepancies
• Identify operational challenges and recommend solutions to improve performance and compliance
• Participate in special projects and perform additional duties as assigned

Skills

Leadership

Team development

Healthcare operations

Analytical skills

Communication

Multitasking

Education

Associate degree

Equivalent combination of education and relevant work experience

Supervisory or leadership experience

Managed care/healthcare experience

Medicaid reimbursement knowledge

Job description

RPMGlobal seeks a Provider Network Operations Supervisor to oversee the daily activities of the Provider Network Operations team, ensuring performance, efficiency, and policy compliance. The role is fully remote for candidates located in Michigan, with monthly in-person meetings in Southfield as needed.

The position requires strong leadership, healthcare operations knowledge, and the ability to drive process improvements in a fast-paced environment.