A managed care plan in Manhattan, NY, is looking for a Manager of Provider Services to join their growing team.
About the Opportunity:
Schedule: Monday to Friday
Hours: business hours
Department: network development/provider services
Work model: combination of travel, office and remote work
Responsibilities: The Manager of Provider Operations will:
Develop metrics and implement plans to execute ongoing network development.
Manage the provider application and contract process to ensure that applications forwarded to credentials are complete.
Develop metrics and implement plans to execute on-going network development to manage network deficiencies.
Manage the provider application/contract process & ensure that applications forwarded to credentials are complete.
Make site visits to provide education to existing and targeted providers
Develop and deliver all provider informational material such as. website page, provider manual, provider quick reference guide and provider newsletter.
Other duties, as needed.
Qualifications:
Bachelor's degree required, preferably in healthcare administration or contracting
3-5 years in managed care, provider relations, contracting or network development.
3+ years supervisory work which includes hiring, planning, assigning and directing work.
Knowledge of health care claims adjudication, medical billing and coding terminology
Knowledge of Medicare as well as healthcare industry claims policies and procedures.