Provider Relations Manager

Description

The Provider Relations Manager is responsible for developing and maintaining service relationships with all PACE participants including physicians, outside physicians and administrators. Responds to electronic and direct inquiries from clients about policies, reimbursement rates, patient referrals, and eligibility. The Provider Relations Manager will work on special projects such as: telehealth, process improvement, community outreach and community engagement, in a supportive role for the effectiveness of the PACE Program. The Provider Relations Manager knows and abides by all PACE Program organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments. Performs job duties in a timely manner and represents the organization in a professional and positive manner. Work with Compliance on credentialing of new and renewals of contracts. 

Requirements

Responsibilities

• Serves as liaison between providers and PACE participants.
• Receives and responds to external provider and participant related issues.
• Develops workflows, strategies, and special projects to meet participant care needs.
• Oversees the implementation plan of Telemedicine between the PACE Program, participants and specialty physicians.
• Provides participant education and participant support in Telemedicine service line.
• Ensures the effectiveness of Telemedicine and maximize the use of Telemedicine for clinical and educational services.
• Represents and promotes the knowledge of PACE to the community. May make travel arrangements, maintains appointment schedules and calendars, and arranges meetings and conferences.
• Manage office supplies and equipment and places order for supplies for their department upon prior approval.
• Answer and respond to phone calls/emails and communicates messages and information to Program Director and/or appropriate staff member.
• Responsible for maintaining confidentiality and providing excellent customer service to program enrollees, their families or designated representative.
• Provider relations consist of several diverse provider contract administrative duties including; direct provider engagement and training, regularly scheduled service visits with targeted providers, network capability monitoring, limited-service contract negotiations and resolution of participant/PACE issues.
• Responds to general provider contract inquiries
• Responds to provider education needs and non-routine claim issues. May research, analyze and recommend resolution for provider disputes.
• Conducts provider outreach by conducting trainings and guidance to enable network providers to become more self-sufficient in confirming eligibility, claims submission and payment by use of available tools.
• Attend and participate in staff meetings, in-services, projects, and committees as assigned.
• Adhere to and support the center’s practices, procedures, and policies including assigned break times and attendance.
• Accept assigned duties in a cooperative manner; and perform all other related duties as assigned.
• Be flexible in schedule of hours worked.
• May require use of personal vehicle

Education & Training

• At a minimum an associate's degree in business, healthcare, insurance or a related field required. Experience may be considered in lieu of education.
• A bachelor’s degree preferred.
• A minimum of three (3) years of demonstrated experience in the healthcare field.
• A Minimum of one (1) year of documented experience working with a frail or elderly population.

Skills & Abilities

• Proficient knowledge of computer skills. MS Office (Word, Excel, Access, PowerPoint, and Outlook).
• Knowledge of general office procedures, equipment and filing systems.
• Ability to communicate effectively, both orally and in writing.
• Ability to quickly learn department policies, procedures, goals, and services.
• Skill: Attention to detail and accuracy.
• Ability to change priorities regularly.
• Proficient knowledge of computer skills, MS Office (Word, Excel, PowerPoint, Publisher, and Outlook). 
• Ability to speak, read, write, and understand English effectively at a level appropriate for the job.

Working Conditions

The working conditions and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Ability to access all areas of the center throughout the workday.
• Ability to lift up to 35 pounds occasionally, 15 pounds frequently, and 7 pounds constantly; required to obtain assistance from another qualified employee when attempting to lift or transfer objects over 25 pounds.
• Requires constant hand grasp and finger dexterity; frequent sitting, standing, walking and repetitive leg and arm movements, occasional bending, reaching forward and overhead; squatting and kneeling.
• Work is generally performed in an indoor, well-lighted, well-ventilated, heated, and air-conditioned environment.