Managed Care Provider Relations Manager jobs in West Virginia

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)

H
Manager Provider Relations
  • Highmark Inc.
  • Remote Position, WV FULL_TIME
  • Company :

    Highmark Inc.

    Job Description : 

    JOB SUMMARY


    This job manages a team of provider relations’ representatives and staff to provide high quality service to providers participating in the organization’s network.  The incumbent motivates a team through the creation of a work environment that fosters a service-driven approach.  The incumbent is accountable for developing positive and strategic relationships with providers and community partners and serves as the point of contact for the department.              
     
    ESSENTIAL RESPONSIBILITIES

    • Manage team of provider relations representatives and support staff in servicing health systems and large providers.
    • Provide information to management regarding identified procedural, operational and contractual improvements.
    • Provide daily oversight of staff responsible for updating and maintaining practice files in applicable systems and providing timely dissemination of practice changes to the appropriate departments.
    • Support internal customer requests.
    • Work closely with other areas to resolve provider service and contracting issues.  
    • Represent the department in workgroups and committees that address both internal and external customer concerns.  
    • Oversee and coordinate all training and mentoring activities for new and existing departmental staff.
    • Other duties as assigned or requested.

    EXPERIENCE


    Required

    • 5 years in the Healthcare or Insurance industry
    • 3 years in a management or leadership role

    Preferred

    • Experience with claims processing and coding


    SKILLS

    • Experience with customer relationship management
    • Strong organizational, analytical and interpersonal skills
    • Very good leadership skills
    • Excellent verbal and writing skills
    • Working knowledge of the pertinent state(s) Medicaid Managed Care contract and managed care in general
    • Experience with conflict resolution
    • Working knowledge of various payment algorithms and methodologies
    • Ability to act as a change agent

    EDUCATION    

    Minimum

    • Bachelor’s degree or 6 years of related and progressive experience lieu of Bachelor's Degree

    Preferred

    • Master’s  degree

    LICENSES or CERTIFICATIONS


    Required

    • None


    Preferred

    • None


    Language (Other than English):

    None

    Travel Requirement:

    0% - 25%

    PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

    Position Type

    Office- or Remote-based

    Teaches / trains others

    Occasionally

    Travel from the office to various work sites or from site-to-site

    Rarely

    Works primarily out-of-the office selling products/services (sales employees)

    Never

    Physical work site required

    No

    Lifting: up to 10 pounds

    Constantly

    Lifting: 10 to 25 pounds

    Occasionally

    Lifting: 25 to 50 pounds

    Rarely

    Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

    Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.


    As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

    Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

    Pay Range Minimum:

    $67,500.00

    Pay Range Maximum:

    $124,800.00

    Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

    Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

    EEO is The Law

    Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf )

    We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.

    For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

    California Consumer Privacy Act Employees, Contractors, and Applicants Notice


  • 3 Days Ago

H
Manager Provider Relations
  • Highmark Inc.
  • UNKNOWN, WV FULL_TIME
  • Company : Highmark Inc. Job Description : JOB SUMMARY This job manages a team of provider relations’ representatives and staff to provide high quality service to providers participating in the organiz...
  • 3 Days Ago

M
Managed Care Financial Analyst
  • Mountain State Oral and Facial Surgery
  • Huntington, WV FULL_TIME
  • Cabell Huntington Hospital is seeking a full-time Managed Care Financial Analyst to work alongside our Contract Management Department. The Managed Care Financial Analyst is responsible for ensuring ac...
  • 1 Day Ago

W
Managed Care Financial Analyst
  • Wroblewski & Newsom, PLLC
  • Huntington, WV FULL_TIME
  • Cabell Huntington Hospital is seeking a full-time Managed Care Financial Analyst to work alongside our Contract Management Department. The Managed Care Financial Analyst is responsible for ensuring ac...
  • 3 Days Ago

S
Managed Care Biller
  • Stonerise Corporate
  • Charleston, WV FULL_TIME
  • Managed Care Biller Due to Company growth, CommuniCare Health Services is currently recruiting a Managed Care Biller for our Corporate Billing Office located in Charleston, WV. PURPOSE/BELIEF STATEMEN...
  • 8 Days Ago

C
Managed Care Financial Analyst
  • CABELL HUNTINGTON HOSPITAL\/ST. MARY
  • Huntington, WV FULL_TIME
  • Cabell Huntington Hospital is seeking a full-time Managed Care Financial Analyst to work alongside our Contract Management Department. The Managed Care Financial Analyst is responsible for ensuring ac...
  • 9 Days Ago

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Relationship Manager
  • BHI
  • Miami, FL
  • Job Summary This positions primary responsibility is new business development and existing / new account management. Ori...
  • 3/28/2024 12:00:00 AM

C
Relationship Manager
  • Claire Myers Consulting
  • Wichita Falls, TX
  • Our client is a dynamic, boutique wealth management firm with a mission to educate the community on all things financial...
  • 3/28/2024 12:00:00 AM

W
Relationship Manager
  • WaFd Bank
  • Boise, ID
  • Min: USD $85,000.00/Yr. Max: USD $130,000.00/Yr. Job Summary: A Relationship Manager is responsible for developing a bus...
  • 3/28/2024 12:00:00 AM

O
Relationship Manager
  • OPENLANE
  • Fredericksburg, VA
  • Who We Are: At AFC (Automotive Finance Corporation) we fuel the entrepreneurial dream in our community. For more than 30...
  • 3/26/2024 12:00:00 AM

W
Relationship Manager
  • WaFd Bank
  • Medford, OR
  • Min: USD $85,000.00/Yr. Max: USD $130,000.00/Yr. Job Summary: A Relationship Manager is responsible for developing a bus...
  • 3/26/2024 12:00:00 AM

B
Relationship Manager
  • BSF
  • Walnut Creek, CA
  • POSITION OVERVIEW: The Relationship Manager is responsible for developing and managing client relationships with local b...
  • 3/26/2024 12:00:00 AM

A
Relationship Manager
  • AFC Automotive Finance Corporation
  • Fredericksburg, VA
  • Who We Are: At AFC (Automotive Finance Corporation) we fuel the entrepreneurial dream in our community. For more than 30...
  • 3/25/2024 12:00:00 AM

C
Service Relationship Manager
  • Cencora
  • Avon Park, FL
  • Our team members are at the heart of everything we do. At Cencora, we are united in our responsibility to create healthi...
  • 3/13/2024 12:00:00 AM

West Virginia (/vərˈdʒɪniə/ (listen)) is a state located in the Appalachian region in the Southern United States and is also considered to be a part of the Middle Atlantic States. It is bordered by Pennsylvania to the north, Maryland to the east and northeast, Virginia to the southeast, Kentucky to the southwest, and Ohio to the northwest. West Virginia is the 41st largest state by area, and is ranked 38th in population. The capital and largest city is Charleston. West Virginia became a state following the Wheeling Conventions of 1861, after the American Civil War had begun. Delegates from so...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Managed Care Provider Relations Manager jobs
$90,630 to $130,740

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