Description:
GENERAL SUMMARY
- Provides direction to Customer Service on policy and procedures related to claims/providers.
- Manages a team of Provider Relations Representatives. Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Facilitates Provider Advisory Group meetings and works with management to implement suggested changes.
- Works with Quality Management to develop appropriate provider measures and implement those measures in the provider community.
- Develops provider communications including provider newsletters.
- Develops and implements provider satisfaction surveys and uses results to manage relationships and educate staff.
- Provides service to provider practices by resolving problems and advising providers of new protocols, policies and procedures.
- Negotiates, reviews, and prepares draft agreements with alternative delivery system facilities, laboratories, and group practices.
- Manages the development and monitoring of provider contracts.
- Resolves administrative problems affecting network providers, patients, and plans within contracted guidelines.
- Oversees the team that ensures the provider data entered into the provider database is accurate and that the provider documentation is complete and accurate.
- Researches and coordinates the resolution of provider’s claims and capitation issues.
- Coordinates provider status information with member services and other plan departments.
- Performs other duties as required.
Qualifications:
- Bachelor’s degree or equivalent experience.
- Management/supervisory experience (5+ years) with exempt level staff.
- Significant experience (usually 5+ years) in benefits interpretation and provider networking.
- Substantive knowledge of managed care policy and direction.
- Knowledge of ICD-9 and CPT codes desired.
- Strong analytic and problem solving abilities.
- Strong communication and negotiation skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: First/Mid Level Officials and Managers
Primary Location: Louisville, KY, US
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2012-11-08 00:00:00.0
Job ID: 1212107
GENERAL SUMMARY
Manages the activities of the Provider Relations Department. Overseas the maintenance of working relationships with the existing network, and assists in the recruitment of new providers. Develops processes to collect and maintain accurate and current provider databases relating to provider facilities and physician information. Assists in the development of policies and procedures. Develops and implements training programs and educational materials for Providers as well as internal staff.
ESSENTIAL RESPONSIBILITIES
- Provides direction to Customer Service on policy and procedures related to claims/providers.
- Manages a team of Provider Relations Representatives. Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions including, employment, termination, performance reviews, salary reviews, and disciplinary actions.
- Facilitates Provider Advisory Group meetings and works with management to implement suggested changes.
- Works with Quality Management to develop appropriate provider measures and implement those measures in the provider community.
- Develops provider communications including provider newsletters.
- Develops and implements provider satisfaction surveys and uses results to manage relationships and educate staff.
- Provides service to provider practices by resolving problems and advising providers of new protocols, policies and procedures.
- Negotiates, reviews, and prepares draft agreements with alternative delivery system facilities, laboratories, and group practices.
- Manages the development and monitoring of provider contracts.
- Resolves administrative problems affecting network providers, patients, and plans within contracted guidelines.
- Oversees the team that ensures the provider data entered into the provider database is accurate and that the provider documentation is complete and accurate.
- Researches and coordinates the resolution of provider’s claims and capitation issues.
- Coordinates provider status information with member services and other plan departments.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience.
- Management/supervisory experience (5+ years) with exempt level staff.
- Significant experience (usually 5+ years) in benefits interpretation and provider networking.
- Substantive knowledge of managed care policy and direction.
- Knowledge of ICD-9 and CPT codes desired.
- Strong analytic and problem solving abilities.
- Strong communication and negotiation skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: First/Mid Level Officials and Managers
Primary Location: Louisville, KY, US
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2012-11-08 00:00:00.0
Job ID: 1212107