Managed Care Provider Relations Manager jobs in Edmond, OK

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)

A
Provider Relations Manager
  • Absentee Shawnee Tribe of Indians of Oklahoma
  • Norman, OK FULL_TIME
  • This position is currently open.

    Public?:
    Internal
    Division:
    Health
    Reports To:
    Medical Director
    Type of Position:
    Regular Full Time
    Location:
    Little Axe Health Center / 15951 Little Axe Dr. / Norman, OK 73026
    General Description
    Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all practitioners who provide patient care within the Absentee Shawnee Tribal Health System. Responsible for ensuring practitioners are credentialed, appointed and privileged with health plans. Maintain up-to-date data for each practitioner in online credentialing data base and practice management system for billing; ensure timely renewal of licenses and certifications. Partial oversite of Credentialing Specialist.
    Responsibilities
    Processing initial credentialing and re-credentialing applications
    Screening practitioners’ applications and supporting documentation to ascertain their eligibility
    Collecting information from the National Practitioner Data Bank (NPDB), the applicant and their malpractice insurer
    Collecting primary source credentialing and privileging verification, via AMA, AOA, ECFMG, OIG Exclusions List, Licensing Board, DEA and OBNDD verification, National Student Clearinghouse, Board Certifications
    Identifying discrepancies in information and conducting follow up
    Assist Credentialing Specialist to present completed initial and re-appointment credentialing applications to the Credentialing Committee
    Present completed initial and re-appointment credentialing applications at monthly Health Board Meeting
    Distribution, research and working knowledge of Medical Staff Bylaws, Rules and Regulations. Assist with the development of the Medical Staff Bylaws, policies, procedures, rules and regulations to ensure that the medical staff is aware of changes.
    Prepare reports, letters and other confidential materials
    Track, validate expiring licensure, DEA certificates, OBNDD, malpractice coverage and any other required credentialing documents for all practitioners to ensure timely renewals
    Auditing Medical Staff Credentialing files
    Responding to health plan provider inquires
    Maintains knowledge of current health plan and agency requirements for credentialing practitioners
    Sets up and maintain practitioner Medical Staff Appointment/Re-Appointment files in online credentialing data base and practice management system
    Ensures practice addresses are current with health plans, agencies and other entities
    Audits health plan directories for current and accurate provider information
    Maintains confidentiality of practitioner information
    Edit or amend contracts and handle terms of contract breach
    Prepare, review and evaluate contracts for compliance of legality and for profitability if applicable
    Negotiate insurance contract terms and reimbursement rates on an annual bases
    Assist Medical Director with monthly practitioner meetings; Journal Club monthly meeting; OSMA CME monthly training; OSMA practitioner yearly CME event
    Assist Medical Director/Health Attorney with provider employment agreements
    Assist Credentialing Specialist/Deputy Director with peer review and maintaining confidential folders
    Track, audit, review and maintain credentialing hold claim status, add insurance effective dates within eClinicalWorks practice management system
    Assist Medical Director/Deputy Medical Director as needed
    Practitioner time clock, tracking vacation/sick leave
    Maintaining bi-monthly provider meetings, agendas and monthly notes
    Track, complete and maintain insurance contracts for CompleteCare Home Health
    Track and maintain practitioner CME budget
    Submit reimbursements for licensure, membership, subscriptions and book orders through Microix
    Coordinate with the Travel Specialist/Medical Director regarding practitioner travel/training
    Coordinate student schedules with HR, Medical Director, Deputy Medical Director and all other departments as directed
    Coordinate the onboarding process with HR, EHR, and Administration for new hire practitioners
    DIA system access form and Provider digital signature forms collected and completed to assist EHR
    Maintain partial oversite for the Credentialing Specialist
    Knowledge and understanding of the credentialing and privileging to maintain AAAHC Accreditation
    Ability to organize and prioritize work and manage multiple priorities
    Ability to work independently with minimal supervision
    Performs other duties as assigned
    Education Requirements and Qualifications
    Required Qualifications:
    Education: High School Diploma / Some College Preferred
    10 years of previous credentialing experience within a healthcare environment preferred
    Knowledge and understanding of the credentialing process
    Ability to organize and prioritize work and manage multiple priorities
    Excellent verbal and written communication skills including, letters, memos and emails
    Excellent attention to detail
    Ability to research and analyze data
    Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization
    Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources
    Preferred Qualifications:
    Associate degree / Certified Provider Credentialing Specialist (CPCS) / Certified Professional Medical Services Management (CPMSM)
    Previous experience working with a Native American entity.
    Physical Requirements and Working Conditions
    Must be able to sit, stand, stoop, bend or kneel for long periods of time.
    Sitting or standing or walking for long period of time; occasional bending, squatting, kneeling, stooping; good finger dexterity and feeling; frequent repetitive motions; talking hearing and visual acuity.
    Frequent lifting (up to 15 lbs)
    Occasional lifting (up to 30 lbs)
    Native American Preference/EEO/Drug Free Workplace/Smoke Free Workplace
    Posted Date:
    1 day 23 hours ago
    Closing Date:
    Saturday, November 18, 2023


    Tribal Preference/Native American Preference/EEO/Smoke Free/Drug Free Workplace
    Indian preference applies to all positions, but all resumes will be accepted.


    Forward Completed Absentee Shawnee Tribe applications with resume to:
    Absentee Shawnee Tribe
    Human Resources Department
    2025 South Gordon Cooper Dr.
    Shawnee, OK 74801
    Fax: 405-273-2710
    Email: HR@astribe.com

  • 1 Month Ago

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Provider
  • Immediate Care of Oklahoma
  • Norman, OK FULL_TIME
  • Description Maintaining the Immediate Care standard and demonstrating Character First traits through daily action at all clinics. Encouraging others to maintain a positive attitude, professional work ...
  • Just Posted

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Provider
  • Immediate Care of Oklahoma
  • Choctaw, OK FULL_TIME
  • Description Maintaining the Immediate Care standard and demonstrating Character First traits through daily action at all clinics. Encouraging others to maintain a positive attitude, professional work ...
  • 28 Days Ago

I
Provider
  • Immediate Care of Oklahoma
  • Oklahoma, OK FULL_TIME
  • Description Maintaining the Immediate Care standard and demonstrating Character First traits through daily action at all clinics. Encouraging others to maintain a positive attitude, professional work ...
  • 29 Days Ago

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PBM / Managed Care Pharmacist
  • Pharmacy Careers
  • Oklahoma, OK FULL_TIME
  • We are currently seeking a skilled and motivated Pharmacist with expertise in Pharmacy Benefit Management (PBM) and Managed Care. In this pivotal role, you will be responsible for overseeing medicatio...
  • 1 Month Ago

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Childcare Provider
  • Kid Care Collective
  • Oklahoma, OK PART_TIME,FULL_TIME
  • **Childcare Provider** Kid Care Collective is a non-traditional childcare center. We follow a more montessori approach to our childcare. We can help you obtain all required training and certificates. ...
  • 11 Days Ago

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0 Managed Care Provider Relations Manager jobs found in Edmond, OK area

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Sales Representative - Payments
  • Heartland
  • Edmond, OK
  • Sales Representative - Payments Are you a sales professional looking to join a company that's on the rise? Look no furth...
  • 4/23/2024 12:00:00 AM

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Pharmacy Relationship Manager
  • Healthcare Marketing Group Llc
  • Oklahoma City, OK
  • Whether you are working in a Pharmacy looking for additional income, an established healthcare sales professional, or lo...
  • 4/23/2024 12:00:00 AM

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Financial Consultant Partner- Oklahoma City
  • Charles Schwab
  • Edmond, OK
  • Position Type: Regular Your opportunity At Schwab, youre empowered to make an impact on your career. Here, innovative th...
  • 4/22/2024 12:00:00 AM

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Financial Consultant Partner- Oklahoma City
  • Charles Schwab
  • Oklahoma City, OK
  • Position Type: Regular Your opportunity At Schwab, youre empowered to make an impact on your career. Here, innovative th...
  • 4/22/2024 12:00:00 AM

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Financial Consultant Partner- Oklahoma City
  • Charles Schwab
  • Bethany, OK
  • Position Type: Regular Your opportunity At Schwab, youre empowered to make an impact on your career. Here, innovative th...
  • 4/22/2024 12:00:00 AM

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Relationship Manager - Multiple States
  • Exencial Wealth Advisors
  • Oklahoma City, OK
  • RELATIONSHIP MANAGER (Preferred location: Oklahoma, Texas, or North Carolina, flexible) Exencial Wealth Advisors is seek...
  • 4/21/2024 12:00:00 AM

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Regional Sales Manager - Oklahoma City, OK
  • Snap Finance LLC
  • Oklahoma City, OK
  • **Regional Sales Manager - Oklahoma City, OK** at Snap Finance Oklahoma, United States **Regional Area Sales Manager - (...
  • 4/21/2024 12:00:00 AM

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Travel CT Technologist - $1,858 per week
  • Hiring Now!
  • Oklahoma City, OK
  • Springboard Healthcare is seeking a travel CT Technologist for a travel job in Oklahoma City, Oklahoma. Job Description ...
  • 4/21/2024 12:00:00 AM

Edmond is a city in Oklahoma County, Oklahoma, United States, and a part of the Oklahoma City metropolitan area in the central part of the state. As of the 2010 census, the population was 81,405, making it the sixth largest city in the state of Oklahoma. The city limits are located on the northern border of Oklahoma City. Three major highways connect Edmond to downtown Oklahoma City: U.S. Route 77 (the Broadway Extension), which runs through the center of Edmond, and Interstate 35, which runs along the eastern side. Public transportation is provided by Citylink Edmond bus service. Additional...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$91,817 to $132,448
Edmond, Oklahoma area prices
were up 1.2% from a year ago

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