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Presbyterian Healthcare Services · 2 weeks ago

Provider Network Management Relations Executive

Albuquerque, NM

Contract

Onsite

Mid Level

$51K/yr - $78K/yr

3+ years exp

Presbyterian Healthcare Services is hiring a skilled Provider Network Management Relations Executive to join their team. The role involves overseeing network strategies and relationship development activities for assigned providers, ensuring alignment with clinical quality initiatives and facilitating communication between the provider and health plan.

AssociationHealth Care

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

Qualification

Provider relations experienceProvider contracting knowledgeClaims processing experienceRisk sharing programsReimbursement methodologiesPersonal computing skillsVerbal communication skillsWritten communication skillsPresentation skillsInterpersonal skillsNegotiation skillsFacilitation skillsOrganizational skills