Managed Care Provider Relations Manager jobs in West Virginia

Company :

Job Description :

JOB SUMMARY

This job manages a team of provider relations’ representatives and staff to provide high quality service to providers participating in the organization’s network. The incumbent motivates a team through the creation of a work environment that fosters a service-driven approach. The incumbent is accountable for developing positive and strategic relationships with providers and community partners and serves as the point of contact for the department.

ESSENTIAL RESPONSIBILITIES

• Manage team of provider relations representatives and support staff in servicing health systems and large providers.
• Provide information to management regarding identified procedural, operational and contractual improvements.
• Provide daily oversight of staff responsible for updating and maintaining practice files in applicable systems and providing timely dissemination of practice changes to the appropriate departments.
• Support internal customer requests.
• Work closely with other areas to resolve provider service and contracting issues.
• Represent the department in workgroups and committees that address both internal and external customer concerns.
• Oversee and coordinate all training and mentoring activities for new and existing departmental staff.
• Other duties as assigned or requested.

EXPERIENCE

Required

• 5 years in the Healthcare or Insurance industry
• 3 years in a management or leadership role

Preferred

SKILLS

• Experience with customer relationship management
• Strong organizational, analytical and interpersonal skills
• Very good leadership skills
• Excellent verbal and writing skills
• Working knowledge of the pertinent state(s) Medicaid Managed Care contract and managed care in general
• Experience with conflict resolution
• Working knowledge of various payment algorithms and methodologies
• Ability to act as a change agent

EDUCATION

Minimum

• Bachelor’s degree or 6 years of related and progressive experience lieu of Bachelor's Degree

Preferred

• Master’s degree

LICENSES or CERTIFICATIONS

Required

Preferred

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

No

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

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