Managed Care Provider Relations Manager jobs in Alabama

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)

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Managed Care Contract Specialist
  • Highmark Health
  • AL, AL FULL_TIME
  • 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%

    • Manages Out-of-Network work queue and evaluates Qualified Payment Amounts. Ensures organizational compliance with No Surprises Act Requirements by negotiating single care agreements timely.15%
    • Administers the Contract Repository System and ensures that Managed Care Contracts are stored timely and accurately into Contract Repository system.

    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%

    • Coordinates special projects and provides organizational support for the Managed Care department.Ensures that project deadlines are met and project documentation is maintained appropriately. 10%
    • Other duties as assigned or requested.

    QUALIFICATIONS : Minimum

    Minimum

    • Bachelor's Degree in Finance, Accounting, Business Administration, Economics, Statistics, or related field, or 6 years of progressive healthcare related experience as determined by the company in lieu of bachelor's degree
    • 3 years of healthcare related experience
    • Advanced computer skills using Microsoft Office (Word, Excel, and PowerPoint, Adobe, etc.)
    • Substantial organizational skills, including multitasking and time-management
    • Reliable customer service, follow-up, and communication skills
    • Ability to work effectively both independently and as part of a team
    • Continuously searches for process improvements to achieve accuracy and efficiencies
    • Strong critical thinking, problem solving abilities, and attention to detail

    Preferred

    1 year of Managed Care experience

    Pay Range Minimum : $25.85

    $25.85

    Pay Range Maximum : $40.18

    $40.18

    Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation / gender identity or any other category protected by applicable federal, state or local law.

    Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation / gender identity, protected veteran status or disability.

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    Equal Opportunity Employer Minorities / Women / Protected Veterans / Disabled / Sexual Orientation / Gender Identity ()

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    2 days ago
  • 4 Days Ago

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In Home Care Provider
  • Home Instead Senior Care
  • Huntsville, AL PART_TIME,FULL_TIME
  • Now Offering Same Day Pay with Tapcheck!Looking for a rewarding job working with Seniors? We are looking for compassionate, trusted Caregivers to join our Home Instead family! As a Caregiver, you are ...
  • 3 Days Ago

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Provider Scribe
  • Urgent Care South
  • Warrior, AL FULL_TIME
  • Urgent Care South in Warrior, AL is looking for one provider scribe to join our strong team. We are located on 143 White Oak Trail. Our ideal candidate is a self-starter, ambitious, and reliable. Resp...
  • 15 Days Ago

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Application Manager - MPD (Managed Pressure Drilling)
  • Weatherford
  • AL KHOBAR, AL FULL_TIME
  • Overview Weatherford is a leading global energy services company. Our world-class experts partner with customers to optimize their resources and realize the full potential of their assets. Across our ...
  • 2 Months Ago

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Childcare Provider
  • Little Lambs Child Care and Preschool
  • Rogersville, AL FULL_TIME
  • We are open 7:00 - 5:30, Monday - Friday and you must have open availability during these hours! Must be reliable, dependable, and have a love for children! Must be 18 and have a high school diploma o...
  • Just Posted

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Childcare Provider
  • We Care Child Development Center
  • Phenix, AL PART_TIME,FULL_TIME
  • Child Care TeacherUrgent HirePLEASE PROVIDE COVER PAGE AND/OR RESUME DETAILING EXPERIENCE IN CHILD CARE FACILITY Childcare Educator Job Description: We are currently looking for a friendly and compete...
  • 8 Days Ago

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Relationship Manager
  • BHI
  • Miami, FL
  • Job Summary This positions primary responsibility is new business development and existing / new account management. Ori...
  • 3/28/2024 12:00:00 AM

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Relationship Manager
  • Claire Myers Consulting
  • Wichita Falls, TX
  • Our client is a dynamic, boutique wealth management firm with a mission to educate the community on all things financial...
  • 3/28/2024 12:00:00 AM

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Relationship Manager
  • WaFd Bank
  • Boise, ID
  • Min: USD $85,000.00/Yr. Max: USD $130,000.00/Yr. Job Summary: A Relationship Manager is responsible for developing a bus...
  • 3/28/2024 12:00:00 AM

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Relationship Manager
  • OPENLANE
  • Fredericksburg, VA
  • Who We Are: At AFC (Automotive Finance Corporation) we fuel the entrepreneurial dream in our community. For more than 30...
  • 3/26/2024 12:00:00 AM

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Relationship Manager
  • WaFd Bank
  • Medford, OR
  • Min: USD $85,000.00/Yr. Max: USD $130,000.00/Yr. Job Summary: A Relationship Manager is responsible for developing a bus...
  • 3/26/2024 12:00:00 AM

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Relationship Manager
  • BSF
  • Walnut Creek, CA
  • POSITION OVERVIEW: The Relationship Manager is responsible for developing and managing client relationships with local b...
  • 3/26/2024 12:00:00 AM

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Relationship Manager
  • East West Bancorp, Inc.
  • New York, NY
  • Introduction Since 1973, East West Bank has served as a pathway to success. With over 120 locations across the U.S. and ...
  • 3/26/2024 12:00:00 AM

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Relationship Manager
  • AFC Automotive Finance Corporation
  • Fredericksburg, VA
  • Who We Are: At AFC (Automotive Finance Corporation) we fuel the entrepreneurial dream in our community. For more than 30...
  • 3/25/2024 12:00:00 AM

Alabama (/ˌæləˈbæmə/) is a state in the southeastern region of the United States. It is bordered by Tennessee to the north, Georgia to the east, Florida and the Gulf of Mexico to the south, and Mississippi to the west. Alabama is the 30th largest by area and the 24th-most populous of the U.S. states. With a total of 1,500 miles (2,400 km) of inland waterways, Alabama has among the most of any state. Alabama is nicknamed the Yellowhammer State, after the state bird. Alabama is also known as the "Heart of Dixie" and the "Cotton State". The state tree is the longleaf pine, and the state flower is...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$92,463 to $133,385

Managed Care Provider Relations Manager in Trenton, NJ
Rizk says McKesson has created a collegial relationship by reaching out to providers.
January 03, 2020
Managed Care Provider Relations Manager in Gary, IN
Aetna (57% favorable/37% unfavorable) has turned around providers by changing leadership and addressing provider concerns.
February 24, 2020
Managed Care Provider Relations Manager in Birmingham, AL
Providers "want legitimate, honest P4P programs, data exchange, streamlined business processes, and clarity.
November 28, 2019