Provider Network Management Relations Executive - job 1 of 2

Overview

Now hiring a Provider Network Management Relations Executive

Provides oversight of network strategies and relationship development activities for assigned providers including individualized planning, training and development of providers to align with Presbyterian s clinical quality initiatives. Will provide the framework for physician/provider performance reporting that will assist providers with objective and quantitative analysis of clinical quality performance measures. The Network Relations Service Executive is a professional accountable for proactively identifying issues, resolving disputes, and coordinating resolutions. Accountable for resolving complex problems, fielding general questions, and acting as a liaison between the provider of service and the health plan.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

 

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: Yes
• Job is based at Rev Hugh Cooper Admin Center
• Remote work from home: this job is intended to be conducting in the state of New Mexico.
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.
• Remote: Open to remote applicants in the United States, except for the following states: Wyoming, North Dakota, Ohio, California, New York, Iowa, and Illinois

Ideal Candidate: Three years experience in provider relations, provider contracting, claims processing, or customer service in a healthcare organization. Strong working knowledge of risk sharing programs and different reimbursement methodologies i.e. capitation, DRG, Relative Value Systems, etc. 

Qualifications

• Three years experience in provider relations, provider contracting, claims processing, or customer service in a healthcare organization. Strong working knowledge of risk sharing programs and different reimbursement methodologies i.e. capitation, DRG, Relative Value Systems, etc. Must demonstrate strong verbal, written communication, and presentation skills with strong interpersonal and negotiations skills and ability to interface with providers. Must also possess strong facilitation, organizational, and personal computing skills
• Education:Essential:High School Diploma or GED

Responsibilities

• Collaborates and maintains relationships with providers and staff throughout Presbyterian to ensure an exceptional provider experience.
• Develops and maintains cooperative working relationships between PHP, institutional provider and individual providers.
• Provides education on quality initiatives, managed care, capitation, products, policies and procedures, reimbursement issues, referral/authorization process, etc.
• Responsible for ensuring provider data integrity and accuracy by ensuring PIF s are completed timely and accurately and through a comprehensive review and validation of provider directory data.
• Responsible for post payment validation of assigned providers to ensure accuracy of payment to the contract and corresponding fee schedules.
• Resolves provider issues - claims, health services, finance, etc.
• Stimulates and fosters professional development of the Network Relations Service Associates.
• Supports Network Contracting strategies in an effort to preserve a robust provider network.
• Serves as primary liaison between the provider and the health plan.
• Maintains a general knowledge of health plan reimbursement methodologies.
• Conducts provider visits based on established departmental goals, which will require 50-65% field contact.
• Engages and supports leadership and peers by promoting and participating in department initiatives and being accountable for achieving business objectives.
• Provides consulting and educational support to providers regarding appropriate health care access and navigation of the healthcare system to improve provider satisfaction.
• Participates in a value-added manner both individually and in a team environment, process improvement teams and business initiatives.
• Follows appropriate confidentiality requirements.
• Practices respecting and valuing the differences in each person and demonstrates an inclusive style that fosters dialogue for collaborative solutions in recommending healthcare resources.

Benefits

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian? As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Maximum Offer for this position is up to

USD $36.48/Hr.

Compensation Disclaimer

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.