JOB SUMMARY

The Manager, Provider Network Operations is responsible for establishing and maintaining the Provider Operations team, processes, and systems impacting providers and member satisfaction. The role is accountable for the overall provider experience by working in collaboration with internal partners to drive on-going service improvements, understand, articulate and resolve service impacts, and drive overall provider solutions. Individual seeks to build and continuously improve the relationship between USFHP and the Network.

RESPONSIBILITIES

• Act as a key resource to external providers and internal key stakeholders as it pertains to operational issues impacting provider and member satisfaction;
• Monitor, review and trend provider concerns received across all provider segments as well as any complaints received; leverage data to implement strategies to further enhance provider plan experience;
• Collaborate and consult with internal leaders and department to improve operations and resolve issues impacting provider satisfaction and payment;
• Work collaboratively with Manager, Contracting and Business Analytics to build strong partnership with provider community by cultivating open communication and ensuring Account Leads are aware of provider pain points relative to claims disputes;
• Hire, direct, and mentor Provider Ops team to ensure job functions are completed appropriately and according to priorities; Develop guidelines and measures for the provider relations team that align with corporate goals and measures;
• Develops policies and procedures, process improvement initiatives to foster and optimize network relations and partnerships; Develops and participates in presentations to existing and prospective providers; Ensure data integrity of provider manual, provider directory, web search, etc.;
• Support team members in the identification and creative problem resolution for improved processes
• Ensure department staff remains current in all aspects of Tricare and DHA, regulations, policies and procedures and creates or modifies departmental policies to reflect changes; and
• Perform other duties as assigned.

EXPERIENCE & COMPETENCIES

• 5-8 years of relevant experience in managed care, provider relations, contracting or network development.
• 3-5 years of supervisory experience which includes interviewing, hiring, training employees. Planning, assigning and directing work. Appraising performance. Addressing complaints and resolving problems.
• Knowledge of provider network development, provider contracting and management theory.
• Knowledge of health care claims adjudication, medical billing and coding terminology.
• Knowledge of TRICARE, Medicare and healthcare industry claims policies and procedures.

OTHER REQUIREMENTS

• Bachelors Required - Preferred in Healthcare Administration/Contracting Masters Preferred
• Advanced Proficiency of MS Office, Word, Excel, Access & PowerPoint
• This position will require travel. Candidate must have access to reliable transportation.

SVCMC IS AN EQUAL OPPORTUNITY EMPLOYER - ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, SEXUAL ORIENTATION, GENDER IDENTITY, NATIONAL ORIGIN, DISABILITY OR VETERAN STATUS.

Job Type: Full-time

Pay: $85,000.00 - $100,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Ability to commute/relocate:

• New York, NY 10001: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Managed Care: 5 years (Required)
• Contract negotiation: 5 years (Required)
• Network Development: 5 years (Required)

Work Location: Hybrid remote in New York, NY 10001

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