Provider Relations Manager, Phone Team

 

I.  Purpose of the Job:


The Provider Relations Manager, Phone is responsible for coordinating, monitoring, and ensuring the timely, accurate response to provider phone calls, management of Provider Relations Phone Associates, identification of provider issues related to policies/procedures/systems, and assistance with development of internal policies and procedures.  These phone calls include calls to the general Provider Relations Service Team skill and the PEP Provider Relations Assist skill.  This entails designing workflow processes, creating tracking mechanisms, monitoring reports, communicating phone statistics, and interfacing with associates within Provider Relations, other Plan departments, consultants, vendors, and providers.

 

II.  Job Accountabilities

? Oversee the activities of the Provider Relations Phone Associates, including provider education, project outreach, timely/accurate response to provider inquiries with first call resolution when possible, and meeting or exceeding targets for staff performance for call center average speed of answer and abandonment rate. Monitor the phone skills to ensure that the skills are active and closed when appropriate.  Manage and train staff to ensure superior customer service, provider education/communication of Plan policies and procedures, contract terms & conditions and Plan strategic initiatives, provider problem resolution, and optimal representation of the Plan in the provider community.  Review staff performance while sitting with staff and also telephone call monitoring.  Ensure training of all staff on QCARE, CPF, SAWS, Plan policies and procedures, and regulatory and business changes that impact Provider Relations.  Track, trend and report phone skill activity reports, Provider Relations Phone Associates provider documentation activity reports either though SAWS or telephone inquiry forms, and various provider request logs such as materials, applications, site visits, and orientations.(70%)

? Assist participating providers with escalated issues that require coordination of various Plan departments. This includes but is not limited to provider requests for Plan materials, provider questions regarding contracts and fees, the Plan?s website and IVR, information in the Plan?s Provider Manual/Practitioner Handbook, application status, and claim inquiries.  Assist other departments with inquiries related to providers. This includes but is not limited to questions regarding par status, member compliant resolution, and requests for provider recruitment. These departments include but are not limited to Relationship Managers, Claims, Care Management, Quality Management, EDI, Grievance and Appeal, Customer Service, Enrollment, Marketing, Special Investigations, Credentialing, Provider File Operations, and Provider Communications.  (20%)

? Represent department at internal and external meetings with providers, or other Plan departments.  This includes but is not limited to large provider group orientations and question and answer meetings, individual provider meetings, interdepartmental Plan meetings, and industry conferences/fairs.  (5%)

? Prepare and maintain departmental policy and procedure manuals, and forms.  Provide input and support in the preparation of provider updates, communications, manuals, directories and education materials. Assist in developing and supervising protocols and procedures for ongoing provider service.  (5%)

 

 

 

 

III.  Job Dimensions
This position has responsibility to independently complete assigned tasks while also identifying barriers and opportunities for improvement.  The incumbent will make decisions regarding the resources and information needed to complete work in a timely manner.

This position directly supervises phone based employees and assistance with management of  other teams will also be required at times.




IV.  Key Job Relationships:
This position has regular and frequent contact with individuals within the Provider Relations Department, and other Plan departments such as Government Programs, Complaint and Grievance Department, Care Management, Quality Improvement, MIS, Member/Customer Service, Claims, and Legal.  External contacts include consultants and providers.

 

V. Job Qualifications:

A Bachelors degree in health care related field, Public Administration or Management and 2-3 years of experience in a managed care setting.  Three to five years experience in a healthcare or health insurance environment will also be considered in lieu of a 4 year degree.   

 

? Knowledge of healthcare industry, healthcare delivery systems, and managed care.

? Strong customer service skills and the ability to maintain an excellent rapport with providers and their staff.

? Excellent communication skills, written and verbal, to ensure that the appropriate requests are articulated and that problems are accurately represented for resolution.

? Interpersonal skills to effectively maintain working relationships to get issues resolved or to obtain information through people, and to represent the Plan and the department in a favorable light.

? Ability to be successful in managing a phone based staff and to manage a phone based system and associated reports.

? PC skills including proficiency in email, spreadsheets, and word processing.  Database application proficiency a plus.