Kurten, TX 77862. Provider Relations Manager Cover Letter Our team of writers is native English speakers from countries such as the US with higher education degrees and go through precise testing and trial period. Ability to interpret Provider contracts, Establish and maintain relationships with Providers to ensure quality and satisfaction of services provided, Capacity to address complex problems including claims issues and customer service complaints; work with other departments to achieve resolution of the issues, Demonstrated ability to identify areas of opportunity within Provider networks for improving overall efficiency and quality, Familiarity with all Microsoft Office programs with experience using Outlook task management tools, Working knowledge of Medicaid, Medicaid Manage Care and or Health Plan Managed Care, Excellent communication skills verbal and written, Excellent bilingual public speaking skills, Organizational, multi tasking, and time management skills, Proven success in contributing to an individual and team oriented environment, Excellent leadership, communication written and oral and interpersonal skill, Must be able to travel within the designated region, as well as to the central Accenture location in Austin as requested by Leadership, Independent thinking, problem resolution with strong organizational capabilities, Proven ability to exercises judgment within defined procedures and practices to determine appropriate action, Minimum of 1 year Medicaid, Medicaid Managed Care and or Health Plan Managed Care experience, Telephonic outreach to providers, conveying key program messaging, Meets compliance criteria following established guidelines, Achieves successful completion of visit based upon rigorous time frames, Thoroughly documents and follows up as applicable, Communicates to designated customers following protocol, Schedules travel to achieve maximum efficiency based upon assigned visits, Represents Accenture professionally and creates a positive reflection to providers Meets established quality metrics, Collaborates with leadership and team to meet established goals and maximize efficiencies, Working knowledge of Medicaid, Medicaid Managed Care and or Health Plan Managed Care, Excellent communication skills verbal and written Microsoft Products, Ability to self-monitor, follow directions and meet deadlines, 1) Lead the development and management of provider relationships throughout the state, including both regionally important providers as well as broad network of independent clinics and hospitals, 2) Direct a statewide staff of contract managers. If selected for this role, you will be required to be screened for TB, Three years healthcare industry experience working in Provider Relations, Knowledge of Long Term Care Manage Care Plan, Bachelors degree in health- or business-related field, 2-4 yrs in successful experience in completing efficient health-related research, with associated analysis and conclusions, Excellent PC skills (including MS Word, Excel and Access) required, Excellent communication skills, written and verbal, Humana is seeking an individual to focus on servicing Humana's provider community, Educate providers about Humana's products and services, Receive, document and resolve provider inquiries by using established best practices, Coordinate and facilitate regularly scheduled provider meetings to discuss operational service and issue resolution strategies, Collaborate with internal partners to achieve market and enterprise goals, Prior experience in health care, managed care health plan or related setting, Strong relationship building skills, preferably in a provider relations/network environment, Comprehensive knowledge of Microsoft Office Suite, Excellent verbal & written communication skills with demonstrated presentation skills, Demonstrated organizational skills and ability to manage multiple priorities, Ability to travel within the state of North Carolina to include occasional overnight stays with no restrictions, Bachelor's Degree in Business, Finance or related fields, Knowledge of CPT coding systems, Medicare claim processing and regulations, Ability to meet production goals without compromising product quality and integrity, 10 key skills by touch and solid typing skills, Competency to utilize Company software and proficiency in Microsoft software applications and a willingness to learn new systems as necessary, The incumbent must be able to perform this job safely, without endangering the health or safety of him/herself or others, 7+ years of experience in Contract Negotiations, Network Development, Health Care Management, or Managed Care and/or Provider Relations; 5+ years of Supervisory experience, Bachelor's Degree in Health Care Administration, Business Management or an equivalent combination of education and related work experience in Managed Care or Health Care, Microsoft Office/Suite proficient (Word, Excel, and Access), Experience working directly with physicians and an understanding of how physician groups operate, Proven ability to work consultatively with physicians using data to support changes in providing care and operational processes, Experience partnering with senior leadership on strategic initiatives, Risk sharing/value based reimbursement knowledge, Demonstrated leadership ability and proven ability to lead through influence, Comprehensive knowledge of all Microsoft Office applications with a high level of proficiency with Excel, Ability to travel locally 50%-75% during the day, MSO and/or ACO experience strongly desired, Provider Contracting/Network Management knowledge, Applies understanding of the goals and objectives of the Medicaid Administrative Services Program and work within area of responsibility to ensure success, Coordinates resources to ensure excellent customer service; works collaboratively with Provider Relations management team to develop and implement strategic initiatives, Assists in preparation and updating of provider publications, Assists Department staff with public presentations, symposiums, and workgroups, Builds and maintains relationships with external stakeholders, Conducts formal training seminars and informal onsite assistance at provider offices, Contacts providers with identified billing issues to offer onsite service/visit, Coordinates/conducts orientations and training for newly enrolled providers and established providers to ensure they understand their roles and responsibilities, billing procedures, and program policies, Designs and develops workshops, in-service sessions, and conference materials, Develops education materials to include articles for bulletins, flyers, and any necessary correspondence to assist in educating providers on Medicaid issues, Maintains consistent communications with providers, including communication of policy changes/updates, Works closely with service center departments to identify and address provider education issues through office visits, workshops or other educational venues, Maintains documentation of provider visits, provider communications (verbal and written), and any necessary follow-up activities, Maintains schedule of regular provider office visits for goodwill and problem-solving efforts, Maintains working knowledge of the Medicaid Administrative Services Project Program policies and procedures and communicate information to external (provider community) and internal stakeholders, Participates in local medical community organizations, Promotes and demonstrates electronic claims transmission software to encourage provider participation, Represents Xerox and the Medicaid Program throughout the State and at professional association meetings, Researches and resolves provider inquiries and claims processing issues, Understands and applies the project management methodology to ensure efficient on-time delivery and high-quality results, Understands and applies the MMIS Quality Assurance practices in fulfilling all day-to-day job responsibilities, Requires driving to provider offices, workshops and provider association meetings, Bachelors degree preferred or one to two years related experience in the healthcare field, preferably Medicaid experience, Must live in the primary territory location or in a contiguous county which representative will serve, Experience in conducting public speaking events/training, Provide general administrative support to the Provider Contracting department, including typing, scheduling, and coordinating services, Support Humanas providers and communicate with Humanas clients in order to facilitate greater physician understanding and cooperation during the contracting process, Prepare, assemble and mail contracts on behalf of Humana, tracking the contracts activity and regularly reporting its status, Maintain all provider contracts and credentialing files, Prior experience in an administrative support role, Comprehensive knowledge of Microsoft Office applications, Prior health care industry experience in the areas of contracting or operations, Strategically manage in-force provider contracts, sharing Humanas value proposition through frequent contact and education and proactively administering the relationship process, Implement local strategic plans in order to effectively influence providers, provider affairs and service centers, Ensure that retention rates and positive negotiations meet and regularly exceed network targets, Contribute to the training and development of other associates in the Provider Contracting area, Manage multiple projects, collect and analyze data and disseminate to appropriate departments as necessary, Bachelors Degree in Business, Finance or a related field or a minimum of 3 years relevant business experience, Prior demonstrated success in provider contracting or provider relations, Oversee a team which analyzes and identifies key claims processes that need to be improved, Identify and resolve barriers to performance from determining root cause analysis, creating process mapping and resolution implementation, Working knowledge of Strataware/CompIQ, and/or Call Track, Understanding of State rulings and regulations as relating to Workers Compensation, Understanding of medical bill processing rules and guidelines, Provide prompt, courteous and accurate customer service, Perform administrative tasks such as managing faxes and phone message retrieval within 24 hours, Facilitate the processing of PRIORITY request to ensure that bill review processors make the necessary changes with 48 hours, Demonstrate the ability to work both individually and in a team environment, Respond to provider issues and direct problem resolution, Set an example of courtesy and professionalism for all co-workers and customers, Complete additional work assignments as required by management, Demonstrate the ability to use Stratraware/CompIQ and Citadel to locate claim information (by social security number, claim number or patient name) to provide current status (check information, authorization and/or compensability), Analyze Call Track data to determine that the information gathered is correct and calls can be resolved, Maintain a schedule adherence rating of 95% or higher, Maintain a quality level of 3.0 or higher (scale 1-5), Demonstrate an understanding of the Bill Review guidelines and procedures, Demonstrate professional attitude and communication at all times with coworkers, Adhere to the Bill Review Department Dependability guidelines, Ability to use Microsoft Windows-based software, Ability to learn and apply basic medical terminology, Ability to assess and document reconsideration issues, Minimum one (1) year of Customer Service experience or six months of Medical Bill Review processing, Two (2) years experience in Customer Service Department, Two (2) years experience in Workers Compensation, Two (2) years experience in a medical setting, Six (6) months experience in Bill Review Department, Health care or managed care with Provider Contracting, Network Management or Provider Relations experience, Demonstrated management experience and partnering with senior leadership on strategic initiatives, Ability to travel with Provider Service Consultants to provider offices in the Memphis and surrounding areas as needed, Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance, Comprehensive knowledge of Medicare policies, processes and procedures, Updates and maintains on network tracking system the current status of pending and renewing vendor applications, Schedules and organizes outreach presentations and serves as educator/liaison with providers to ensure providers are current on HAEC programs, policies & procedures, billing practices, accessibility standards and contracted service requirements, Responds to corporate office requests to obtain updated status on pending contracts and outstanding documentation and/or compliance issues, Attends trade organization events, conferences and business networking meetings on a regular basis to market HAEC products and programs, This role is part of Humanas Driver safety program and therefore requires an individual to have a valid state drivers license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits, Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work, Must have accessibility to high speed DSL or Cable modem for a home office (No Satellite), Must possess strong communication skills, both verbal and written, Knowledge of all Microsoft Office programs, 10+ years of experience working in a Healthcare environment; 5+ years of Management experience, Bachelors Degree in Business or related field, Managed Care Contract development and negotiations experience, Solid knowledge and understanding of the Managed Care industry and local market conditions, Strong working knowledge of current Healthcare Market trends and products available in the community, Working knowledge of Medicare and Medicaid programs, Refers to reference library of fee schedules, CPT, ICD-9, HCPCS and other industry publications to research and support findings, Communicates with States Workers Compensation agencies, Identifies problems, provides solutions and resolves promptly. Respond to provider/facility questions via the telephone and email; conduct problem solving and research on issues related to claims denials, authorizations, and credentialing, re-credentialing and general provider/facility inquiries daily.All provider conversations/inquiries must be documented within same day of receipt, Work closely with the Credentialing department to audit all new provider applications, work to secure needed documents for credentialing and re-credentialing upon receipt and/or request from Credentialing upon 3 failed attempts as needed, Maintain databases and produce accurate internal reports for facilities, individual providers and groups. Provider Relations Manager who excels in operations analysis and outstanding human relations and leadership skills. Working closely with Provider Contracting and Retail Network Operations, Partner with practice staff and act as a single point of contact to field and resolve physician/practice questions/issues regarding fee schedules, referral simplification, patient population confirmations and other ad hoc network projects by coordinating across Steward teams to ensure task completion and/or resolution, In conjunction with provider enrollment, help physicians maintain current contact and practice information in the Steward provider database that feeds the web-based tools used by patients to contact and select Steward providers, Monitor production in assigned territory and work with key stakeholders to develop and maintain strategies that address deficiencies, Ensure effective communication with other teams to assure Provider Relations issues are managed quickly and efficiently, Provide quality assistance to HouseCalls Practitioner field by quickly and efficiently addressing practitioner concerns, Provide practices with both requested and network distributed reports, Progressive levels of responsibility related to claims processing, Comprehensive knowledge of all Microsoft Office applications, including Word, Project and Visio, Supports SNP implementation locally; collaborating with key implementation stakeholders, Manage the various accounts and internal/external relationships associated with the SNPs; develop new and maintain existing physician relationships with Nephrologists and other providers participating in VillageHealth Government programs, Develop and maintain relationships with health plan partners to pull all non-clinical levers to improve plan and product performance, Deliver executive level presentations to key stakeholders inside and outside of the DaVita Healthcare partners organization, Develop knowledge of competitive products and external factors in each market, Assist Provider Relations Manager in developing training materials, Assists and cooperates with co-workers, supervisor and management, Resolve administrative problems affecting network providers, patients, and plans within contracted guidelines for which the network is responsible, Assist with the development and monitoring of provider contracts, Provides timely assistance to DPHO providers on all other matters related to DPHO physician participation in DPHO MCO contracts, Proactively establishes and maintains positive working relationships with MCO executives, DPHO physicians, and DPHO practice managers, Identifies and establishes relationships with key providers involved in delivering an effective care delivery model to ESRD patients, Knowledge of accountable care organizations care desired, Knowledge of managed care and integrated delivery networks, Conducts oneself professionally and courteously during interactions with others, Knowledge of general office machines and telephone system, Ability and willingness to work cooperatively with others, Promotes professionalism in appearance, respect for others, positive attitude, and confidentiality, Important notification to applicants as of Nov. 20, 2014: Effective Jan. 1, 2015, Centura Health will no longer hire tobacco users in Colorado and Kansas. Provider Relations Manager Cover Letter | Best Writing Service Rebecca Geach #15 in Global Rating 4.8/5 Connect with one of the best-rated writers in your subject domain. Works with external vendors when appropriate, Manages Provider Relations mail and correspondence. ), Conduct data driven operations meetings with assigned network of providers which includes IPA/medical groups, PPO providers/provider groups and Hospitals; Ability to drive critical discussions with assigned network of providers to deliver established quantifiable goals and targets, Execute provider relationships and performance strategies, Support assigned provider book of business in a customer-focused, effective and efficient manner, Organizes and follows up with internal functional areas to ensure resolution of claims and service problems, External facing position that develops and maintains deep and long lasting relationships with providers, Customize education and trainings to meet the needs of providers as well as effectively delivering it in group settings, Coordinate escalated claim disputes and all necessary research timely and effectively which may require some reliance on their manager and senior level peers in setting action plans to analyze and resolve root cause issues, Coordinate and monitor providers compliance with regulatory requirements, Work closely with their assigned IPA/medical groups to ensure compliance with Access & Availability requirements, Complete Transition & Disengagement Reports required by the Department of Managed Health Care when IPA/medical groups or Hospitals submit termination notices, Ability to lead ad-hoc projects/assignments and actively participate in all internal and external meetings, The job requires moderate level of autonomy in decision making since PRCs main customers (providers) need to rely on the PRCs for answers to issues that need immediate resolution, 3-5 years of experience in provider relations or health care, Bachelors degree preferred, or equivalent work experience, Strong relationship-building and account management skills, Understanding of medical insurance products and associated provider issues, Demonstrated ability to develop strong working relationships with matrix partners in organizations; ability to leverage matrix resources to drive deliverables, Demonstrated strong oral, written, interpersonal, presentation, analytical, and persuasive skills, Demonstrated planning/organizational skills; ability to plan for both the long and short term; ability to work on many issues at once and to prioritize work, Ability to use PC software and multiple CIGNA systems, 3 years related experience in health plan marketing to physician, physician relationship between hospital and physician, Knowledge of hospital or provider office setting required, Promotes a team environment, willing to assist others, and responds timely to providers and hospital staff, Must be able to multi-task numerous initiates and work efforts, AA degree preferred or equivalent work experience, 2 years sales and/or account or vendor management experience, Ability to draft clear, concise and grammatically-correct communications to providers and other constituents, Ability to clearly and efficiently communicate telephonically with providers, Willingness and ability to provide direct and constructive feedback to vendors as part of a mutually beneficial partnership, Proficient in basic Microsoft applications (Word, Excel, and Outlook) and Bright Horizons back-up applications (SLX, BLX, and PCA), Motivated to meet and exceed goals as an individual as well as contribute to the success of a larger team, Provide pro-active and on-going communication and education to designated providers staff regarding HPI products, policies, procedures, and systems. Proactive in flagging and developing solutions for process inefficiencies. ), One to three years experience in a Provider Services position working with providers, Three to five years experience in the managed care/health insurance industry, Demonstrated strength in working independently, establishing influential relationships internally and externally, meeting and training facilitation skills, priority setting and problem solving skills, Manages the MCO claims dispute and resolution process for multi-specialty network of providers. Dear Mr. Gonzalez, I am writing to express my interest in your Relationship Manager position at Alliance Data. Exceptional computer skills, including Microsoft Office applications.
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