Sr. Provider Network Manager

About the role

The Sr. Manager of Provider Network leads and manages provider contracting and network developments consistent with the strategic goals of Prominence Health Plan. This position ensures the satisfaction of Plan Participating Providers by maintaining excellent relationships and facilitating growth and retention.

Responsibilities

• Effective provider communications and network management
• Contract negotiations
• In depth rate analysis
• Initial and ongoing education and support for all network products
• Analyze specific issues pertaining to providers
• Oversee the management, problem resolution and education of the provider network on Prominence Health Plan products, services policies and procedures
• Facilitate the development and implementation of educational strategies to effectively communicate to Prominence Health Plan providers and other key audiences as well as current and ongoing educational initiatives

Qualifications and Requirements

• Bachelor’s degree or equivalent experience required
• Five years’ working experience in managed care
• Experience in working with medical claims billing/payment processes
• Experienced in negotiating provider rates schedules that can achieve the best possible rates per provider, per line of business and can be automated in various claims billing systems
• Experienced in analyzing rates, negotiating contracts and preparing documents i.e., Agreements, amendments, reports, analysis, addendums and letters of agreement
• Knowledge of provider reimbursement, Medicare reimbursement, coding and HEDIS Measures and care gap reporting preferred
• Ability to develop and implement strategic initiatives
• Knowledge of Medicare Advantage and ACA risk scores and ability to educate providers and key leavers to further enable the health plan’s success
• Understanding of provider office dynamics and optimal approaches to communicating and educating providers and provider staff
• Understanding of provider reimbursements and coinciding challenges (FFS, CPT code reimbursement, etc.)
• Ability to effectively communicate in English, both verbally and in writing
• Excellent computer skills
• Highly developed professional, interpersonal, written and oral communication skills
• Experience in building and maintain provider relationships
• Highly accountable, organized, detailed
• Ability to develop and implement strategic initiatives

About Universal Health Services

One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (UHS) has built an impressive record of achievement and performance. During the year, UHS was again recognized as one of the World’s Most Admired Companies by Fortune; and listed in Forbes ranking of America’s Largest Public Companies. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.