This position manages the programs designed to foster positive relations between physicians and organizations insurance plan and network of physicians and hospitals. Must be familiar with a variety of managed care concepts, practices and procedures while increasing the provider network.
Oversees the daily operations of the provider relations functions. This includes providing input on employment decisions, orienting new employees, preparing work schedules, monitoring staff productivity and providing performance evaluations.
Manages the activities of the external provider relations employees including provider education, problem resolution, recruiting, and service monitoring and contracting activities.
Manages the activities of the internal provider relations employees including working the claims buckets, loading new contracts, physician updates and problem resolution.
Manages the activities of practice support agreement providers to ensure the providers are credentialed with a variety of managed care payors.
Participates in organizational audits to ensure organizational compliance with health plan requirements.
Manages activities related to the preparation of provider manual, provider notification materials and contributes to other publications as requested.
Serves as an integral part of the team tasked to develop and implement the emergency on-call program for the organization.
Provides expertise to the provider relations staff, physicians, health plan personnel and other departments on benefits, reimbursement and contract/regulatory changes.
Must possess a strong knowledge of business and/or healthcare as normally obtained through the completion of a bachelors degree in business, healthcare or related field.
Must possess a strong knowledge and understanding of healthcare planning and management as normally demonstrated through three to five years of managed care and management experience. Provider relations experience required.
This position requires a thorough knowledge of managed care and governmental reimbursement methodologies, the ability to analyze financial ramifications of decisions, excellent interpersonal skills and exceptional organizational abilities. Must be able to communicate effectively with others by speaking, reading, and writing. Relies on extensive experience and judgment to plan and accomplish goals.
Additional related education and/or experience preferred.
Internal Number: 246882
About Banner Health
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.