Managed Care Provider Relations Manager develops, manages, and sustains relationship with members of physician network of managed care service providers. Recruits new physicians and manages the credentialing and orientation process. Being a Managed Care Provider Relations Manager serves as a resource for physicians, answering questions and providing information about network procedures or contracts. Monitors provider performance and resolves any issues. Additionally, Managed Care Provider Relations Manager reviews billings and claims payments according to managed care contracts. Requires a bachelor's degree. Typically reports to the head of a unit/department. The Managed Care Provider Relations Manager manages subordinate staff in the day-to-day performance of their jobs. True first level manager. Ensures that project/department milestones/goals are met and adhering to approved budgets. Has full authority for personnel actions. Extensive knowledge of department processes. To be a Managed Care Provider Relations Manager typically requires 5 years experience in the related area as an individual contributor. 1 to 3 years supervisory experience may be required. (Copyright 2024 Salary.com)
Your Role
The Provider Support team for Claims and Payment Models is a specialized unit within the Network Management and Provider Partnerships organization that is accountable for improving the provider experience and streamlining operations. The Provider Relations Representative, Consultant will report to the Senior Manager. In this role you will be responsible for assisting providers including Facilities, Large Systems, and Physicians contracted for value-based payment models with escalated claims and payment issues. Internally, you will be responsible for partnering with cross functional teams including Provider Relations, Contracting, Claims, Clinical, Legal & Compliance, Data Analytics, Information Technology, and Innovation to facilitate issue resolution, identify root causes, and deliver operational improvements.
Your Work
In this role, you will:
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0 Managed Care Provider Relations Manager jobs found in Long Beach, CA area