provider relations manager cover letterprovider relations manager cover letter

provider relations manager cover letter28 May provider relations manager cover letter

charge master neutralizations), Work with Contractor and Provider Consultant to assist with and follow up on routine provider contracts, Ensures initial credentialing, managing unresponsive providers through re credentialing, and resolves discrepancies, Supports with complete system set up for delegation of credentialing and any provider network data needed for other forms of delegation. Must have strong analytical abilities. Enter and update notes on all assigned providers, Monitor, facilitate and respond to all voicemails (24-48 hour call back), emails (24-48 hours reply), and CAPs (resolution within 30 days) within required timeframe specified for each. My enclosed resume and this cover letter will tell you more about my background. EMR connectivity; E2E Contract TAT) to support comprehensive department reporting package overseen by Network Performance. Knowledge of Humanas internal policies, procedures and systems, Bachelors Degree or equivalent job experience, Minimum five years in Medicaid or other healthcare related field, Three years leadership experience preferred with one year of management experience, Two years of claims examination and/or billing experience, Problem solve through analysis and ongoing feedback, Functions as the single point-of-contact for all on-going contractual and service issues as needed by providers and develop and implement solutions that are beneficial to providers, Humana members, and the business-at-large, Educate providers about Humanas ever-expanding portfolio of products and services, ensuring continually updated knowledge about the companys offerings, Analyze data for cost reduction initiatives, guaranteeing profitable and efficient business relationships, Previous experience in provider contracting/provider relations, Regularly communicates with the Care Management team on Provider Relations updates and issues, Evaluates member service needs reports to ensure that there are sufficient providers contracted to meet member care needs, Negotiates and maintains contractual relationships with vendors in areas of service needs, Schedules and organizes outreach presentations and serves as educator/liaison with providers to ensure providers are current on AEC programs, policies & procedures, billing practices, accessibility standards and contracted service requirements, Attends trade organization events, conferences and business networking meetings on a regular basis to market AEC products and programs, Consistently meets established productivity, Valid Driver's License and current auto insurance, This role is considered patient facing and is part of Humanas Tuberculosis (TB) screening program. Experience working with computers in Windows environment preferred, Conducts ride-alongs with Reps. in the field to develop skills and behaviors and document progress/provide formative feedback through timely and consistent Field Trip Reports, Must be able to travel up to 50% in assigned market, Preferred a Bachelor's Degree in a related field, Intermediate ability to lead/manage others, Advanced knowledge of healthcare delivery, Strong functional and technical knowledge of healthcare delivery, Advanced ability to influence internal and external constituents, Advanced knowledge of CMS and state regulations, May oversee work activities of other supervisors, Product, service or process decisions are most likely to impact multiple groups of employees and / or customers (internal or external), Leading Joint Operation Committee with network providers, Day to day interactions with the provider network, Monitoring and ensuring compliance with regulatory requirements, 3+ years of provider relations and / or network management experience, Advanced level of proficiency with MS Word, Excel, and Access, Advanced level of knowledge of claims / systems processes, contracting and reimbursement methodologies, 6+ months of work or educational experience with interpreting and summarizing large data sets to drive informed actions, 6+ months of work or educational experience sourcing data, and analyzing, trending and producing a forecast from findings, 6+ months of Microsoft Excel experience working with Pivot Tables, v-lookup, sumif etc, Bachelor's Degree (or higher) in healthcare, business or other related field, Professional experience in operations, workforce management or data analysis, Professional experience in data modeling, trending and forecasting, Responsible for coordinating large scale mailing activities for the distribution of provider media materials, publications, amendments, provider manual updates. This includes formal written proposals, establishing baseline and ongoing measurement activities that reflect improvement in services provided, Interfaces with external and internal customers when appropriate to ensure ongoing quality improvement activities are in place and monitored for positive outcomes. Exhibits professionalism in representing oneself and one's team, Associates or Bachelors Degree or equivalent years of provider relations experience, Previous provider experience (provider contract, provider relations, or provider service), Ability to work in a deadline driven environment, Valid drivers license and/or dependable transportation necessary, Prior experience with supporting other complex projects and/or provider networks, Ensures contracts are operationalized from contracting through implementation, leveraging standardized tools and quality processes end to end, Maintains contracts, including making changes and updates using various systems i.e. Resource Based Relative Value System (RBRVS), 1+ years of experience in fee schedule development using actuarial models, 1+ years of experience utilizing financial models and analysis in negotiating rates with providers, At least an intermediate level of knowledge of claims processing systems and guidelines, 1+ years of experience in performing network adequacy analysis, Strong interpersonal skills, establishing rapport and working well with others, Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer, Resolves provider issues by interfacing with HCP central departments (Contracting, Eligibility, Claims and Finance), Reports systemic operational issues to the management team, Coordinates provider outreach for the CCR, Follows up with Payor Contracting department on status of clinicians being added, terminated as well as open / closed panel status based on health plan website and submitted information, Verifies annually the single / dual affiliation status of physicians and follows up when they are not maintaining this status, Serves as a point of contact to central departments for issues related to the network, communicates relevant information from the central departments to the network and provides communications and documents upon request, Makes outreach and follow up phone calls to physician offices related to specific initiatives or meetings (i.e. Extensive and documented experience in communicating with top executives and physicians, Mobilizing Resources - Ability to manage staff and resources consistent with organization goals, Sales Ability/Persuasiveness - Using appropriate interpersonal styles and communication methods to gain acceptance of a product, service or idea from prospects and clients. 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. Works with other departments to ensure collaboration and coordination for specialty and case management programs, Serves as the primary lead in the development, operationalization and evaluation of the Engagement Center's QM portion of the integrated QM/UM work plan. Familiarity with AHCCCS preferred, Accuracy and detail orientation are required, Proficiency with Microsoft Word, Excel and PowerPoint required; knowledge of Microsoft Access, ABS, MACESS is beneficial, Excellent customer service and verbal and written communication skills, Strong analytical skills and ability to use advanced features of Excel to run data analysis and create insightful and professionally presented reports, Effectively analyzes and negotiates contract rate and language proposals, independently solves problems and prioritizes work, Analyzes current network and projected network needs from cost/utilization and competitor standpoints, Provides strategic input on contracting targets and rates for various projects, Makes and receives provider calls, negotiates, time manages daily work activities to meet longer-term project goals and timelines, Keeps detailed and accurate notes regarding all negotiation efforts which may include in the Tracking database as required, Prepares requests for fee schedule and contract loading that accurately reflect contract language, rates and intent, if applicable, Takes lead on escalated issues from assignment through closure, Two or more years contracting experience in healthcare, Or any combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position, Solid understanding of health plan products/lines of business, familiar with basic medical contracting methodologies and claims pricing/reimbursement strategies, Knowledge of Microsoft Word and Excel required, knowledge of Microsoft Access, ABS, MACESS a plus, Ability to maintain professionalism in response to escalated provider calls, Ensure appropriate and effective communication with the Clinical Team Managers in the field within assigned territory, Conduct market specific analysis to manage capacity according to current production requirements and constraints, Responsible for assuring practitioners have loaded required hours of availability and assignments are made in a timely fashion, Execute practitioner assignments that ensure target outcomes are achieved within assigned territory, Submit timely and accurate reports regarding production in assigned territory, Achieve performance metrics related to telephonic quality assurance, Ability to work an 8 hour schedule starting between 8-11 am and ending between 4:30-7:30 including occasional weekends, Experience with Microsoft Excel (Creating spreadsheets, VLOOKUP, pivot tables, etc.) Provider Relations Manager Cover Letter | Top Writers Attends QOCC meeting, and works collaboratively with clinical, quality and other departments to address quality issues and actively participates in provider monitoring program, Responsible for all Provider deliverables to State and Partners, Responsible for ensuring providers are trained and completion of the provider training plan, Responsible for oversight of the Accountable Care Collaborative provider relations activities and deliverables, Extensive knowledge of managed care environment, network development and network management is required, Excellent communication skills, flexibility, adaptability, problem solving capability, creativity, initiative, teamwork skills, prioritization skills and public relations skills are required, Demonstrated ability to interact and negotiate with mental health, substance abuse, and employee assistance program providers is required, Strong organizational, communication, analytical, problem solving and staff management and budget management skills are required, Ability to manage in a geographically disbursed, complex and changing environment, Undergraduate degree or equivalent experience, 4+ years of provider relations and / or provider network experience, Must be willing to travel at least 75% throughout Georgia, North Carolina and South Carolina, Bachelors degree preferred or equivalent work experience, 4 years experience in sales and/or account or vendor management, Background in Human Services or Early Childhood Education preferred, Excellent written and verbal communication skills as well as excellent phone manner, Proficient in basic Microsoft applications (Word, Excel, Outlook) and the Internet to source recruitment leads, Ability to multi-task and prioritize in a fast-paced environment, Strong organizational and time management skills as well as attention to detail, Physician, Ancillary and/or LTSS provider relations experience or equivalent, Experience presenting to varied audiences, Bachelors or Masters Degree in Business, Finance or a related field, Initiate calls to new providers targeting specific program needs and target areas in the State, Recruit providers not currently enrolled in Medicaid, Recruit provider that currently have a low participation, Promote and recruit for THSteps Medical and Dental, CSHCN, Family Planning and other services, Promote and recruit providers to use web based applications such as electronic claim submission and the Provider Enrollment Portal, Deliver presentations for professional organizations and teaching schools, Must Reside within the Dallas,Texas area as per the Health and Human Services Commission, Minimum of 1 year of Medicaid, Medicaid Managed Care and/or Health Plan Managed Care experience, Must reside in or be willing to relocate on your own to the Dallas, TX Area, Minimum of 2 years of Microsoft Office experience, Good financial acumen and financial analysis and diagnosis skills, Excellent leadership, communication (written and oral) and interpersonal skill, Solve moderately complex problems and/or conduct moderately complex analyses, 3+ years of experience with provider contracting/provider relations / provider network/provider data, 3+ years of experience in the health care industry, Supports the provider relations department by managing provider relationships through practitioner and facility orientation, provider inquiries, training, attendance at meetings and participation in resolution of complaints as necessary, Answer practitioners/facility questions regarding enrollment, authorization and Beacon/Medicaid policies and procedures, Participate in the maintenance of provider files. What Is Provider Relations? Definition and Examples - Indeed provider relations and call center staff so as to equip them with the background knowledge of processes to assist in their ongoing training of their network providers, Routinely monitors provider performance to target and perform remedial training sessions based upon area of need (e.g., authorization processes, claims submissions, etc. Provider Relations Manager Cover Letter | Best Writing Service Excellent oral and written communiation skills. The change to our policy does not apply to associates hired on or before Dec. 31, 2014. Business Relationship Manager Cover Letter Example diploma; college level education completed or in progress preferred but not required if candidate demonstrates strong aptitude, Health insurance or managed care industry knowledge beneficial, Advanced written and oral communication skills required, PC skills required, including MS Office applications such as Word, Excel, PowerPoint and Outlook, Ability to multi-task and prioritize work assignments, Ability to adapt to change; accountable in team work environment is essential.

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