Provider Relations Manager in New York, NY at Beacon Health Options

Date Posted: 2/5/2018

Job Snapshot

Job Description

About the Position:

We are currently seeking a dynamic Provider Relations Manager to join our team at our office in Manhattan, NY.  The Manager of Provider Relations will be primarily 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 Performs provider outreach and proactive personal contact with providers in their offices and through attendance at professional gatherings.  Provides education and brings provider feedback to the regional or corporate office for action.  Recruits new providers and works to maintain satisfaction of providers to prevent dis-enrollment.  Participates in contract negotiations requiring face-to-face interactions with providers, including group practices and facilities.  Conducts provider office site visits.  Works closely with regional and corporate Provider Relations staff to efficiently deliver services.

Position Responsibilities:

  • Recruits new individual and group practitioners and facilities to join the provider network for Beacon Health Options.  Identifies potential practitioners through independent research, network inclusion requests, or attendance at professional gatherings, and performs preliminary screening and office visits.
  • Facilitates and participates in staff training for new and existing staff;
  • Assists in the development and implementation of policies and procedures;
  • Assist with the completion of applications and gathering of necessary credentialing documents for practitioners and facilities.  Coordinates and facilitates the timely credentialing of new practitioners and facilities joining the network.
  • Negotiates provider contract terms and conditions including reimbursement rates, and coordinates with Contracting Development Directors on more complex contractual issues.
  • Gathering and analyzing claims paid data, utilization data and benefit design information to assist in the development of strategies for contracting and re-contracting.
  • Contracts and re-contracts with providers to ensure effective cost competitive contracts in a defined geographic territory.
  • Performs practitioner and facility orientation and training of office staff on Beacon Health Options policies and procedures and provides updated training throughout the lifecycle of the provider relationship.  Coordinates with other internal Beacon Health Options departments (e.g. clinical) to ensure key operational areas are aware of any provider re-education or training needs.
  • Performs provider and facility outreach to manage the ongoing relationship, and is a critical interface link with regional and corporate provider relations and network operations staff in the seamless delivery of services to providers including:
  • providing feedback to providers regarding their performance under the terms of their contract;
  • identifying and addressing quality of care and service issues, in conjunction with clinical and medical departments;
  • responding to provider complaints and questions as they arise;
  • formulating provider report requests (TSR’s);
  • participating in the local provider advisory committee; and
  • Identifying the need for provider mailings/communications.
  • Manages the dis-enrollment process by meeting with the practitioner or facility, confirming direction, and completing required paperwork for Network Operations.
  • Maintains a regular schedule of provider meetings (may be face to face or telephonic) with high volume and key network providers to maintain a high level of customer service.
  • Participate in regional and national meetings including and not limited, quality management, utilization management, and National Credential Committee.
  • Facilitate provider issue resolution through collaboration with internal departments.

Position Requirements:

  • Education: B.S. Degree in related field required, M.S. Degree in Human Services with a clinical license may be required by some contracts
  • Relevant Work Experience:
    • 3 years of experience in provider relations and facility contract negotiations preferably in a managed behavioral health care setting required 
    • Managed care background (e.g. HMO, Insurance Company) in provider relations, contracting and provider network development is required.  Previous management and/or lead experience is preferred.
  • Knowledge, Skills and Abilities:
    • Demonstrated abilities to interact with and recruit mental health, substance abuse and employee assistance program providers.
    • A demonstrated ability to negotiate financial and contractual language arrangements with facilities that comply with Beacon Health Options policies, procedures and guidelines for multiple lines of business.
    • Excellent written and oral communications skills, flexibility, adaptability, problem solving capability, creativity, initiative, teamwork skills, prioritization skills, public relations and customer service skills are required.
    • Ability to use PC-based word processing and spreadsheet applications, preferably the Microsoft Office suite of products.
    • Ability to travel to local and distant provider offices in assigned region by automobile, air or other means.
    • Proven knowledge of reimbursement methodologies and payment mechanisms.
    • Demonstrated knowledge of claims processes and procedures including coding such as CPT-4 and ICD-9/10.

To Apply:

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Beacon Health Options company 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.