Manager of Primary Care Services

NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND

 

POSITION DESCRIPTION

POSITION TITLE: Manager of Provider Services I  DEPARTMENT: Customer Service

   

REPORTS TO:  Director of Customer Service     HOURS:  37.5

       REVIEW TYPE: * 6 Month  T Annual  FLSA: * Non-Exempt  T Exempt

 

Overview: The Manager of Provider Services leads and facilitates the management, contracting, operations, communication, reporting and data exchange for the provider relationship in support of strategic and corporate business objectives. The Manager of Provider Services is responsible for managing all operational aspects of the relationship. The Manager of Provider Services supervises on a daily basis the work of their assigned Provider Service Team and will collaborate with assigned project managers in the development and planning of the provider contracting and incentive initiatives. The Manager of Provider Services works collaboratively with business and operational units to ensure the provider operations are supported by effective, accurate and efficient business processes; reimbursements are accurately defined, communicated and configured; all provider communications are compliant and reports are accurate, timely and meet all contractual requirements.

The Manager of Provider Services assumes ownership and accountability for the timely and accurate identification and resolution of operational, benefit, data, and communication issues. The Manager of Provider Services will monitor and direct team members? work to meet objectives and timelines. They will also mentor and coach staff to increase skills and provide an opportunity of growth and development.

This position requires experience dealing with one or more of the following specific provider groups: primary care, specialty care, and or hospitals/facilities. 

Qualifications:  

?   Minimum Bachelor?s degree or equivalent of degree and experience of seven to ten years with a managed care organization or a health care related organization (HMO; Medicaid/Medicare preferred), Master?s degree preferred

?  Demonstrated understanding and experience in all aspects of contract negotiation, financial analysis, contract implementation and the actual maintenance of the contractual agreement with practitioners. (For example: Incentive programs, etc.)

?  Ability to negotiate and execute complex contractual relationships to align with specific corporate initiatives, strategies, goals and objectives.

?  Demonstrated experience with managing and cultivating strong business relationships with provider community

?  Understanding of hospital and practitioner reimbursement mechanisms as outlined in the Medicare and Medicaid reimbursement policies

?  Strong computer skills (spreadsheets, Word)

?  Ability to manage multiple projects simultaneously

?  Ability to motivate staff and promote personal development which will also

?  Reflect on the service provided to the NHPRI practioner network

Duties and Responsibilities:  Responsibilities include, but are not limited to, the following:Negotiating with providersMonitors all contractual arrangements with assigned providersDevelops and implements contractual terms (including but not limited to reporting and initiatives) with NHPRI internal teams, including IS, Claims, and Financial ServicesRecommends modifications to policy and procedures for entry into data systems for practitioners (including reimbursement) to improve accuracy of payments to NHPRI networkServes as internal contacting consultant to internal departments on information regarding contractual arrangements with practitioners, CHCs, and large group practicesServes as representative on internal teams regarding NHPRIs contractual obligations to practitionersCultivates strong business relationships with provider communityInsures the satisfactory resolution of operational issues with provider communityAttends ad hoc meetings, scheduled with CHCs and large group practices for the purposes of updating team of contract implementation statuses and reviewing operational issuesEnsuring that network providers receive appropriate and timely responses from NHPRISpecial projects as requested Other duties as assigned

 



  NHPRI is an Equal Opportunity Employer