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Manager, Provider Relations

Company: Evolent Health
Location: Tallahassee
Posted on: February 15, 2020

Job Description:

It's Time For A Change Your Future Evolves Here Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans. Are we growing? Absolutely about 40% in year-over-year revenue growth in 2018 . Are we recognized? Definitely. We have been named one of Becker's 150 Great Places to Work in Healthcare in 2016, 2017, 2018 and 2019, and One of the 50 Great Places to Work in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you're looking for a place where your work can be personally and professionally rewarding, don't just join a company with a mission. Join a mission with a company behind it. What You'll Be Doing: The Provider Relations Manager is responsible for leading our efforts with Providers in the Pensacola market. The position functions as a liaison between Provider Specialists and claims/reimbursement staff to identify and resolve claims issues. - Develops positive working relationships with internal departments. - Meets with or communicates with internal departments routinely, shares finding with PR team to relay back to providers. - Provides education for corrective actions following Plan Policies & Procedures. - Responsible for implementation and/or increased utilization strategies for electronic provider resources such as electronic claims submission and on-line authorizations. Monitors internal queues for provider complaints, inquiries, ensuring timelines are met. - Identifies trends with complaints, creates action plans for high volume providers to remedy. - Maintains knowledge base with State and CMS fee schedules comparable to Plan pricing guidelines. - Maintains working knowledge of the capitation process for PCPs, including the monthly approval process and reconciliation of retroactivity for specific providers. Responsible for compliance with network standards. - Assesses availability standards reported in site visits and prepares quarterly reports Functions as a liaison between Plan and the participating providers by responding to their needs and inquiries and educating providers and their office staff by covering for out of office Provider Specialists. Keeps current on and can relay updated regulations and policies about benefit administration, enrollment, credentialing, claims adjudication, utilization management, quality management, provider contracting, reimbursement methodologies, on-line provider resources and the online authorization process, and provider recognition programs to health plan providers. Tracks and trends provider data within assigned region. Ensures provider data accuracy. - Coordinates education and provider data corrections as a result of encounter file submission errors. - Monitors capitation and provider panel rosters. Participates in cross-functional teams for implementation of Plan goals and initiatives. - Improves provider satisfaction results in conjunction with Quality and Health Management. - Works with all departments to develop and execute strategies for optimally managing medical costs. - Participates in physician committees, attends appropriate industry specific conferences. - Actively participates in the development and distribution of provider communication materials such as Provider Alerts, Provider Manual, Provider Orientation Kit, etc. Assist in coordinating and implementing all aspects of provider workshops, seminars and meetings, as appropriate. Performs other duties and projects as assigned. The Experience You'll Need (Required): - Bachelor's degree or equivalent years of service - 2+ years leading a provider focused process. - 2+ years of experience in Medicaid and/or government managed care products and terminology - Ability to build strong provider relationships - Strong organizational, multi-tasking and time-management skills - Experience with rapidly adapting to process changes - Requires strong competency with Microsoft Office (specifically Microsoft Excel) - Proven ability to work independently and as a team member - Good communication (written and oral), interpersonal, problem resolution and critical thinking skills Finishing Touches (Preferred): - 2+ years of experience with provider relations, field experience strongly preferred - 2+ years of familiarity with region providers and hospitals, preferred - Masters Degree, Preferred.Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.

Keywords: Evolent Health, Tallahassee , Manager, Provider Relations, Executive , Tallahassee, Florida

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