Manager Provider Network Services

The Manager, Provider Network Services is accountable for creating, implementing, and maintaining an effective model for servicing (external facing and via provider portal) professional, hospital, ancillary and specialty care providers and integrated delivery systems in Pennsylvania and Delaware.

MAJOR ACTIVITIES:

1. Manages the relationships between Independence/AmeriHealth and providers' practice administrators, medical directors, and health system administrators to ensure high-quality, provider satisfaction and compliance with contractual obligations, applicable State & Federal regulatory requirements, accreditation standards, and corporate policies.

2. Recruits, retains, allocates and develops staff and create positive working relationships with functional areas, providers, and other external customers/stakeholders.

3. Manages service issues tracking and reporting.

4. Performs analysis of data and trends.

5. Supports and monitors resolution of issues that impact providers, including but not limited to issues regarding claim payments, pricing/reimbursement, provider data file discrepancies, credentialing, Quality Incentive Payments (QIPS), capitation, medical policy, utilization management, cost containment and other compliance initiatives.

6. Uses the information gained during servicing activities to identify and support the identification of significant opportunities to improve operational efficiency, reduce costs and improve provider satisfaction.

7. Works collaboratively with other business areas to improve performance, productivity, efficiency, process, and service response across the organization.

8. Acts as the relationship manager to strategically partner providers with Independence/ AmeriHealth on corporate-wide strategic initiatives and improve the provider experience and overall satisfaction.

9. Supports the development of provider educational materials and reinforces written provider communications relative to new initiatives and changes in medical and claims payment policy and related operational procedures.

Bachelor's degree in Business, Health Administration or a related field/equivalent experience required.

Master's degree preferred.

Experience

Minimum of 5 years progressive experience in a managed care setting required. 5 years progressive supervisory/management experience in managed care preferred. Prior experience working with hospital systems and other facility and ancillary provider types at a management level in Provider Servicing, Provider Contracting or Claims Processing strongly preferred.

Skills & Abilities

1. Excellent analytical, problem-solving, and organizational skills.

2. Excellent written and verbal communication, and interpersonal skills required.

3. Demonstrated leadership experience.

4. Demonstrated ability to manage independently and effectively multiple, competing priorities and projects.

5. Demonstrated experience with MS Office Suite., Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.