Provider Relations Manager; Hybrid

RESP & QUALIFICATIONS

We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a Care First location based on business needs and work activities/deliverables that week.

Responsible for the daily management, coaching, and development of the Provider Relations team including oversight of department operations, promoting quality service, strengthening relationships through proactive training, education, communication, and ensuring complex problem resolution to all network providers in Maryland, DC, Northern Virginia and continuous counties.

• Responsible for improving provider experience; anticipates provider issues and develops a plan to reduce concerns through better alternatives; responsible for issue resolution and escalation as appropriate; sets goals for and works closely with the team to drive performance to ensure provider experience metrics are met or exceeded.
• Provides direction and guidance to staff to explain and coordinate administrative processes and needs; coaches and trains direct reports to ensure a competent and effective workforce with the necessary skills and competencies to provide quality service to both internal and external customers & performs all management duties including hiring, goal setting and monitoring, performance review, budget review, coaching and development of associates, one‑on‑one meetings, conflict resolution, etc.
• Implements ongoing provider education initiatives within area of accountability; seeks to proactively improve level of education over time.
• Responsible for representing Networks Management/Provider Relations in a variety of work groups to support divisional and corporate level initiatives.
• Collaborates with a variety of stakeholders within and outside of the division by managing key initiatives and projects; builds and maintains a solid professional relationship with key personnel representing providers from office workers to managed care executives & manages relationships with external associations including medical societies, Maryland Hospital Association (MHA), American Association of Hospital Administrator Management (AHAM), medical specialty associations, etc.

This position manages people.

Bachelor’s Degree in Business or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

• 5 years experience in healthcare claims and/or service experience.
• 1 year supervisory experience or demonstrated progressive leadership experience.

• Advanced degree as evidenced by MBA & knowledge of Care First provider relations systems, processes and contracts.
• Experience working with healthcare providers, ideally in a payer setting.

• Strong interpersonal skills. Ability to work independently, as well as a member of a team.
• Strong critical reasoning skills in clinical decision‑making, planning and organizing.
• Working knowledge of provider community, provider reimbursement, medical terminology, CPT coding and CMS 1500 or CMS 04.
• Ability to determine priorities and meet deadlines.
• Strong customer service skills.
• Proven effective written and interpersonal communication skills, well organized, ability to multi‑task and work independently, promote flexibility and teamwork. Strong PC skills with experience using Microsoft Office applications.
• Strong problem‑solving ability, critical thinking, and analytical skills.
• Ability to train and mentor staff.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

$92,320 – $171,369