Manager, Provider Relations in Woburn, MA at Beacon Health Options

Date Posted: 9/28/2018

Job Snapshot

Job Description

About The Position:

The Manager of Provider Relations is responsible for oversight of day-to-day operations of the Provider Relations Representatives within the Department; including, but not limited to, daily coordination of work load with staff, performance management, and higher level support and guidance with provider relations issues and/or inquiries.  The position will support and execute provider relations aspects of the provider strategy for existing business as set forth by Corporate Network Management, Regional Operations and Partnerships leadership.

Position Responsibilities:

  • Effectively lead the Provider Relations team as evidenced by provider, internal customer and client satisfaction, compliance with internal, client, regulatory and accreditation standards, successful audits, and employee satisfaction and engagement.
  • Oversee provider relations staff to assure day-to-day activities are performed effectively and support the Region’s network strategy, including meeting financial targets.
  • In collaboration with Network Management Leadership, execute on a process improvement strategy which identifies provider satisfaction impacts and root cause of issues to achieve shorter provider inquiry response times, improved employee engagement, and higher provider satisfaction.
  • Serve as the network escalation point for Regional Leadership on provider relations issues.
  • Assist providers to facilitate successful credentialing and re-credentialing.
  • Assure the Provider Relations team is accountable to Network Management Leadership, Corporate Operations, and Regional Teams by meeting internal and external performance standards and guarantees.
  • Develop strong provider relationships built on trust and collaboration. Manage and balance Beacon and provider expectations.
  • Develop a provider servicing strategy that is aligned with overall regional and corporate provider partnership strategies. Create guidelines around frequency, content and measurement of service standards to ensure team goals are met. Develop and maintain territory assignments for provider relations representatives based on ability, strategic focus or other corporate or departmental priorities.
  • Maintain in-depth, accurate and current working knowledge of all relevant policies and procedures, and acts as a departmental resource in these areas. 
  • Responsible for provider orientation and training on contractual responsibilities and Beacon policies and procedures. Ensure materials used with contracted providers are accurate and appropriate for the given situation.
  • Work with Manager, Provider Communications to create, review and implement communications such as newsletters, provider manual, mailings, and training programs to educate providers on plan policies or engage them in specific initiatives.  Support member outreach and provider engagement in working with key providers to increase plan awareness as well as retain and grow membership.
  • Act as a key resource to external providers and internal key stakeholders as it pertains to operational issues impacting provider satisfaction.
  • Collaborate with the Quality and Legal Departments to perform complaint and grievance resolution and communication.
  • Collaborate with the Network Development team to transition new business to ongoing operations.
  • Acts as liaison and maintain productive working relationships with all Beacon departments.
  • Report on and trends operational issues, analyzes root cause and implements solutions.
  • Maintain provider satisfaction and assures network adequacy.
  • Perform annual staff reviews and establish individual/team goals for development.
  • Motivate team members to reach department goals and objectives.
  • Acts as a team mentor by leading by example and guiding with a sense of integrity and team work.
  • Meet regularly with team members for one on ones and staff meetings.
  • Partner with management to identify areas of opportunity within department and makes improvements on processes, culture, or work environment.
  • Identify misconduct and finds resolution and escalate to Human Resources.
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Other Job Functions:

  • Maintain professional growth and development through self-directed learning activities.
  • Adhere to all Beacon policies and procedures and standards of operations.
  • Complete all required and assigned trainings.
  • Attend all mandatory company or department meetings.
  • Display a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.
  • Assists management with identifying opportunities for staff improvement, high performing team members, and training needs of team members.
  • Assist team members and offers suggestions to improve processes, culture, or work environment.
  • Performs special projects and other duties as assigned and required.
  • Ensure compliance with regulatory and NCQA requirements.
  • Travel to all company sponsored events, trainings, and locations based on business needs.

Position Requirements:

  • Education: Bachelor’s degree required.
  • Relevant Work Experience: Two to three years of supervisory experience. Three years of provider relations experience. Three to five years healthcare payor (including managed care) experience preferred

To Apply:

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Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled