Supervisor Provider Network Operations

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

Role Overview:

The Provider Network Operations Supervisor supports the daily operations of the Provider Network Operations team by overseeing staff performance, ensuring operational efficiency, and maintaining compliance with internal policies and contractual requirements.

Work Arrangement:

• Remote - This position is fully remote; the candidate must be located in Michigan (MI) and attend monthly meeting as needed in Southfield, MI.
• Requires reliable high-speed internet (minimum 50 Mbps download / 5 Mbps upload)
• Internet reimbursement may be available where required by law or contract

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

Education & Experience:

• 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 a healthcare environment preferred
• Knowledge of claims processing, coding, payment, and/or provider data operations strongly preferred
• Familiarity with Medicaid reimbursement methodologies preferred

Skills & Abilities:

• Strong leadership and team development capabilities
• Knowledge of healthcare operations, particularly claims and provider data
• Analytical and problem-solving skills with attention to detail
• Ability to manage multiple priorities in a fast-paced environment
• Strong communication and interpersonal skills
• Ability to identify process improvement opportunities and drive change