Provider Network Manager - Campbell, United States - Insight Global

Description

GENERAL SUMMARY OF DUTIES:

The Manager of Network Management and Member Services is responsible for overseeing the operational activities of the Network Management and Member Services departments

What you will do:

• Supervises a staff consisting of Network Management Associates both in house and remotely, and a Network Management Coordinator whose primary function is to provide provider support/education and interaction with contracted Health Plans (HMO and PPO)
• Responsible for managing network provider education of applicable policies and procedures
• Responsible for supervising daily provider inquiries, including capitation and reimbursement issues
• Assist in development of physician communication programs and strategy
• Responsible for maintaining strong relationships with contracted Health Plans (HMO and PPO) Communicates with payors and network providers, both orally and written, in association with operational and contractual related issues
• Oversees client related projects
• Assist in identifying issues, problems, and areas where performance could be improved
• Represent organization at physicians' offices, contracted health plans, and committees when necessary
• Develop and present educational pieces at network provider meetings
• Primary responsibility for periodic statistical performance reporting of Network Mgt activities
• Insure adequate physician network retention, expansion and recruitment
• Assist with the development of strategic plans for servicing network physicians and members
• Develop, recommend, and implement new policies and procedures when appropriate

What you will need:

• Advanced knowledge of managed care market, strategies, and physician compensation models
• Working knowledge of medical group/IPA operations
• Excellent verbal and written communication skills
• Excellent public speaking and interpersonal skills
• Able to present oneself professionally and have the ability to address large groups of people in educational forums
• Strong research and analytical skills
• Able to research complex contractual documents for interpretive purpose and utilize critical thinking skills
• Willingness to travel locally
• Knowledge of claims payment systems
• Possess excellent problem-solving skills and is able to identify and adapt to shifting priorities

Education:

• Bachelor's degree in business, health care or related field, or equivalent experience required

Experience:

• Four to Five years in health care setting, including progressively more responsible experience in a physician office management or physician relations capacity required
• One to Two years of experience as a manager or supervisor of a department staff