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Director of Provider Relations Hybrid Role

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RCM Health CareNew York, NY
  • Director of Provider Relations Hybrid role (Working Remotely, in the Manhattan Office, and Field)
  • For more than 30 years, this health plan has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
  • They provide the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive list of products.
  • The Director of Provider Relations is responsible for the management and oversight of the provider relations team, including but not limited, to the management of goals and metrics, departmental and cross functional processes as well as ongoing improvement activities.
  • This position develops, implements, and oversees strategies and policies and procedures for building collaborative relationships with providers through provider education, training, regulatory compliance and resolving operational issues.
  • Act as a key resource to external providers and internal key stakeholders as it pertains to operational issues impacting provider satisfaction.
  • Improve the provider experience, in coordination with providers and with the plan through focused education and training, performance reporting, effective communication of new products, benefits, policies or initiatives, and resolution of provider issues across the business.
  • Lead joint quarterly and monthly meetings to review progress and performance opportunities with leadership
  • Ensure timely responses to regulatory agencies (i.e., NYSDOH, Client) in response to all Provider Network regulatory and compliance issues.
  • Develop guidelines and measures for provider relations that align with corporate goals and measures.
  • Review and identify trends on call volume received across all provider segments as well as any complaints received; leverage data to implement strategies to further enhance provider plan experience.
  • Responsible for developing and updating trend reporting/dashboards/issues trackers.
  • Create strategies to improve key performance indicators; analyze performance data and identify opportunities and performance drivers.
  • Work cross organizationally to ensure successful implementation of provider performance programs and agreements.
  • Ensure data integrity of provider directory, web search, etc.
  • Develops processes to educate new and existing providers regarding their contractual responsibilities as well as policies and procedures.
  • Monitor provider concerns, collaborate and consult with internal leaders and department to improve operations and resolve issues impacting provider satisfaction and payment.
  • Participates in cross-functional workgroups to understand impact of plan changes and initiatives on provider network, advocating for providers as appropriate.
  • Working collaboratively with Account Management Team, build strong partnership with provider community by cultivating open communication and ensuring Account Leads are aware of provider pain points relative to claims disputes.
  • Facilitate with marketing and retention department management to identify opportunities in current provider locations and cultivate them in viable prospects to increase enrollment and retention efforts.
  • Develops policies and procedures, process improvement initiatives.
  • Direct and mentor staff to ensure job functions are completed appropriately and according to priorities.
  • Coach team members in the use of data and appropriate analytical tools that support improved quality.
  • Support team members in the identification and creative problem resolution for improved processes and expanded use of technology.
  • Ensures department staff remains current in all aspects of Federal and State rules, regulations, policies, and procedures and creates or modifies departmental policies to reflect changes.
  • Systematically keeps staff informed of policy and procedural changes affecting program and administrative operations.
  • Responsible for department staffing decisions and providers supervision to assigned staff, writes, and performs annual reviews and monitors performance issues as they arise.
  • Responsible for hiring and training process including recommendations regarding staff retention, termination, and succession planning.
  • Coordinates department's efforts with those of other departments.
  • Bachelor's degree, preferably in health care administration, and a minimum of 5-7 years' experience in a managed care government program claims processing/analyzing experience, working with facilities in addressing reimbursement issues
  • Master's degree in Health Administration preferred
  • Knowledge of principles of business and personnel administration, management functions and support service functions and ability to direct and supervise personnel
  • Proficient with Windows-based PC systems and Microsoft Office, Sharepoint
  • Energetic, goal driven leader with who can motivate and mobilize staff to achieve goals.
  • A strategic thinker who can assess implications and formulate plans of action
  • Strong problem-solving capabilities
  • Ability to streamline and improve operational processes and metrics
  • Ability to display a high degree of professionalism, initiative, and excellent judgement in making decisions regarding contractual issues and dealing with politically sensitive situations.
  • Strong relationship building skills to influence and work collaboratively with physicians, hospitals, business leaders and internal departments.
  • Proven ability to balance execution of the strategic vision through leadership and delegation with a willingness to dive into the details as required
  • Demonstrated interpersonal skills (including oral and written) to interact effectively with a diverse range of internal and external constituents, stakeholders, and audiences.
  • A high level of diplomacy to anticipate, recognize and address effectively with politically sensitive issues.
  • Willingness to challenge the status quo and implement creative solutions to inefficient processes.
  • Ability to manage multiple projects simultaneously
  • Drive for Customer Success
  • Build Relationships & Cultivate Networks
  • Highly organized, detail oriented, dependable and professional individual
  • Ability to travel to meet with Providers and their representatives
  • Salary up to $160,000
  • with excellent benefits (including pension plan)

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