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Manager, Provider Relations Analysts

Company: Modis
Location: Camarillo
Posted on: September 19, 2022

Job Description:

Modis Burbank is seeking an experienced Manager, Provider Relations Analyst

At Modis, we use our insight, knowledge, and global resources to make exceptional connections every day. With 60 branch offices located strategically throughout North America, we are positioned perfectly to deliver the industry's top talent to each of our clients. Clients choose Modis as their workforce partner to solve staffing challenges that range from locating hard-to-find niche talent to completing quick-fill demands.

Position: Manager, Provider Relations Analysts

Type: Direct hire

Rate: DOE

Location : Camarillo, CA-- On-Site only once a month.

The Manager, Provider Relations Analysts, under the supervision of the Director of Provider Network Management, is responsible for developing, managing and sustaining relationships with providers. The Provider Relations Manager is responsible for cultivating, maintaining and strengthening provider relationships for a growing and complex organization. In this highly visible position, the Manager of Provider Relations acts as the primary liaison between the Plan and its providers including facilities, groups, FQHCs and individual practitioners. Key responsibilities include establishing positive working relationships with providers, resolving provider inquiries and navigating the nuances of the market, including regulatory requirements. The Provider Relations Manager works directly with internal departments including network operations, account management, member services, clinical operations and claims administration. Represents the Plan in various venues including provider events.

The Manager, Provider Relation's task is to ensure consistent management of all proposals and contracts. This generally includes oversight of the contract management process, as well as development of specific standards for contract negotiations and document management. The Manager, Provider Relation's role in the contract development process and provider network maintenance requires close collaboration with various departments, including Health Services, Health Operations, Decision Support, Finance and Project Management. This role will report to the Senior Director of Network Operations.

SKILLS

* Advanced knowledge of healthcare, managed care systems, the Medi-Cal managed care marketplace and market trends.
* Very strong interpersonal skills, characterized by the ability to mediate and negotiate effectively, to manage relationships and activities that are diverse and complex and the ability to initiate, establish and maintain effective working relationships with individuals at all levels both inside and outside of the company.
* In-depth knowledge of regulatory guidelines, related to managed care.
* In-depth knowledge of contracting reimbursement models.
* Advanced interpersonal skills,
* Demonstrates team leadership, facilitation and coaching skills.
* Computer literate.
* Demonstrated proficiency using spreadsheet, database and word processing software.
* Knowledge of CPT, ICD-9 and 10, DRG, HCPCS, RBRVS, and Provider Capitation is essential.
* Proficiency in utilizing and interpreting financial models and analyses.
* Experience in applying organizational standards when developing requests for proposals, negotiating terms and drafting contracts.
* Strong problem-solving, advanced communication and analytical skills required to Strong Excel spreadsheet skills are required.
* Ability to multi-task and manage multiple projects simultaneously is required
* Develop positive working relationships both internally and externally
* Reflects enthusiasm, self-motivation, and demonstrated ability to work effectively in an interdisciplinary environment.
* Strong verbal and written skills, and ability to convey complex information in a way that others can readily follow.
* Ability to commit to and facilitate an atmosphere of collaboration and team work.

POSITION QUALIFICATIONS

Education: Bachelor's Degree (four-year college or technical school) Preferred, Field of Study: business, healthcare management or related field preferred. Master's Degree: Preferred

Experience: 5 plus years of experience in health care contracting and negotiations 3 plus years of supervisory experience.

Preferred Experience: 6+ years of experience in managed care contracting negotiations for all provider types- physician, hospital and ancillary providers

3+ years experience in hospital and ancillary provider contracting

Computer Skills: Proficient in MS Word, Excel, Access and PowerPoint

Other Requirements:

* Excellent knowledge and experience with Provider Relations and Oversight of provider data entry and provider contract integrity.
* Supervise Provider Relations Team to promote problem solving, communication, excellent service, process improvement and education/development.
* Maintain engaged relationship with high profile network providers/health system.
* Requires inter-department collaboration on projects, business development, network expansion and fortification.
* Knowledge of value based programs along with state and enterprise reporting.
* Medi-Cal Managed Care experience is desired.

Please contact dana.more@modis.com with updated resume for immediate consideration.

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Equal Opportunity Employer/Veterans/Disabled

To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to https://www.modis.com/en-us/candidate-privacy

The Company will consider qualified applicants with arrest and conviction records

Keywords: Modis, Camarillo , Manager, Provider Relations Analysts, Executive , Camarillo, California

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