Managed Care Provider Relations Manager develops, manages, and sustains relationship with members of physician network of managed care service providers. Recruits new physicians and manages the credentialing and orientation process. Being a Managed Care Provider Relations Manager serves as a resource for physicians, answering questions and providing information about network procedures or contracts. Monitors provider performance and resolves any issues. Additionally, Managed Care Provider Relations Manager reviews billings and claims payments according to managed care contracts. Requires a bachelor's degree. Typically reports to the head of a unit/department. The Managed Care Provider Relations Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Managed Care Provider Relations Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)
Description
GENERAL OVERVIEW :
This job serves as the primary negotiator for Single Case Agreements related to non-contracted entities, while also being responsible for facility / ancillary credentialing for the entire Allegheny Health Network.
It maintains compliance with the No Surprises Act by reviewing andnegotiating Qualified Payment Amounts, administering and serving as the subject matter expert (SME) for the Electronic Contract Repository, and maintaining Network Participation Tools for internal and external consumption.
ESSENTIAL RESPONSIBILITIES
Negotiates and processes payor and employer single case agreements timely and accurately. Continually follows up on singe case agreements until complete and ensures compliance with terms of the single case agreement.
Collaborates with Allegheny Health Network (AHN) Revenue Cycle and Managed Care team to ensure proper billing and timely follow-up on single case agreements. 40%
Completes and submits facility credentialing and re-credentialing applications with all payors accurately and in a timely manner (including but not limited to hospital, ASC, and ancillary entities.
Resolves credentialing issues through collaboration with management, related departments, insurers and others as identified.
Monitors and maintains key credentialing dates for all payors.15%
Serves as primary intake for new contract documents and catalogs pertinent contracting language and events. Serves as department SME for Contract Repository System.10%
Maintains patient access matrix for internal consumption. Maintains and updates patient access matrix for external consumption.
Collaborates with IT and Marketing to ensure timely updates to company websites.10%
QUALIFICATIONS : Minimum
Minimum
Preferred
1 year of Managed Care experience
Pay Range Minimum : $25.85
$25.85
Pay Range Maximum : $40.18
$40.18
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