Provider Network Management Relations Executive at Presbyterian Healthcare Services

Location Address

9521 San Mateo NE Albuquerque, NM 87113-2237 Compensation Pay Range: Minimum Offer $53,768.00 Maximum Offer $82,076.80 Now Hiring: Provider Network Management Relations Executive

Summary

• Build your Career. Make a Difference. Presbyterian is hiring a skilled Provider Network Management Relations Executive to join our team.
• Type of Opportunity: Full time Job Exempt: Yes Job is based: Reverend Hugh Cooper Administrative Center Work Shift: Weekday Schedule Monday-Friday (United States of America)

Responsibilities

• Job Description Presbyterian Healthcare is seeking a Provider Network Management Relations Executive.
• Provides oversight of network strategies and relationship development activities for assigned providers including individualized planning, training and development of providers to align with Presbyterian s clinical quality initiatives. Will provide the framework for physician/provider performance reporting that will assist providers with objective and quantitative analysis of clinical quality performance measures. The Network Relations Service Executive is a professional accountable for proactively identifying issues, resolving disputes, and coordinating resolutions. Accountable for resolving complex problems, fielding general questions, and acting as a liaison between the provider of service and the health plan. Some key responsibilities include: Collaborates and maintains relationships with providers and staff throughout Presbyterian to ensure an exceptional provider experience. Develops and maintains cooperative working relationships between PHP, institutional provider and individual providers.
• Provides education on quality initiatives, managed care, capitation, products, policies and procedures, reimbursement issues, referral/authorization process, etc. Responsible for ensuring provider data integrity and accuracy by ensuring PIF s are completed timely and accurately and through a comprehensive review and validation of provider directory data. Responsible for post payment validation of assigned providers to ensure accuracy of payment to the contract and corresponding fee schedules. Resolves provider issues - claims, health services, finance, etc. Stimulates and fosters professional development of the Network Relations Service Associates. Supports Network Contracting strategies in an effort to preserve a robust provider network. Serves as primary liaison between the provider and the health plan.
• Maintains a general knowledge of health plan reimbursement methodologies. Conducts provider visits based on established departmental goals, which will require 50-65% field contact. Engages and supports leadership and peers by promoting and participating in department initiatives and being accountable for achieving business objectives

Qualifications

• Three years experience in provider relations, provider contracting, claims processing, or customer service in a healthcare organization.
• Strong working knowledge of risk sharing programs and different reimbursement methodologies i.e. capitation, DRG, Relative Value Systems, etc.
• Must demonstrate strong verbal, written communication, and presentation skills with strong interpersonal and negotiations skills and ability to interface with providers.
• Must also possess strong facilitation, organizational, and personal computing skills Education: Essential: High School Diploma or GED All

Benefits

• -eligible Presbyterian employees receive a comprehensive

Benefits

• package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary

Benefits

• .
• Wellness Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being.
• Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.
• Why work at Presbyterian?
• As an organization, we are committed to improving the health of our communities.
• From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
• About Presbyterian Healthcare Services Presbyterian exists to improve the health of patients, members, and the communities we serve.
• We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group.
• Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
• Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
• AA/EOE/VET/DISABLED.
• PHS is a drug-free and tobacco-free employer with smoke free campuses.
• We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services