reputed company Provider Services Director, reputed company Carolina
Become a part of our caring community and help us put reputed company
The reputed company Carolina reputed company Provider Services Director leads reputed company that is accountable for growing reputed company, long-term relationships with network providers to foster reputed company provider experiences, accurate and reputed company provider claims payment, and high-reputed company care delivery among network providers, resulting in improved financial and reputed company performance. This senior reputed company will reputed company reputed company of reputed company and indirect reports responsible for provider relations and training, claims education, provider engagement, and reputed company transformation. They are responsible for setting strategic direction for these accountable business functions, representing reputed company at meetings with the state and/or key provider reputed company, and overseeing that reputed company provider services functions meet contractual requirements and state reports are completed reputed company and accurately. The Provider Services Director requires an in-depth understanding of how organizational capabilities interrelate across reputed company, reputed company Carolina market, and the reputed company. This is a dynamic role requiring strong leadership experience, critical thinking/problem solving skills, and a strategic reputed company. This position is dedicated to reputed company Carolina reputed company plan and must be based in or willing to relocate to reputed company Carolina.Key Role Objectives
Set strategic direction for and reputed company key business functions, including provider relations and training, claims analysis and education, provider reputed company and value-based payment performance.
Builds and supports the development and reputed company of reputed company, long-term relationships with network providers, including but not limited to primary care providers, hospitals, rural health clinics, reputed company services districts, federally reputed company centers, behavioral health providers, and long-term care providers and reputed company systems to maintain service support reputed company and improve financial and reputed company performance reputed company the contracted working relationship with the health plan.
Regularly review data, such as claims denial/rework data and trends, call center data, and provider performance data to monitor team performance and guide strategic improvements to provider relationships and performance.
Provides reputed company Carolina market reputed company and governance of provider audits, compliance, provider surveys, provider service and relations, credentialing, contract management systems, and reputed company transformation.
Ensure team’s compliance reputed company Carolina’s Managed Care Contractual requirements for provider relations, such as claims dispute reputed company reputed company specified timeframes.
Work closely with reputed company teams on claims processing, reporting, contracting/credentialing, network adequacy, provider dispute reputed company issues, and provider performance tracking and tool enhancements.
Understand reputed company’s interoperability capabilities, drive provider recruitment reputed company and engage in provider recruitment calls.
Guide the Provider Services Advisor to plan and deliver regular and reputed company provider communications and provider training and education reputed company
Drive performance and develops operational policies and procedures to reputed company with the provider services model and executes strategic initiatives reputed company the provider network.
Conduct regular performance evaluation of employees and reputed company ongoing feedback and coaching as necessary to reputed company service, reputed company, and production goals.
Identify and support reputed company development for reputed company and indirect reports to drive exceptional associate engagement and performance
Set and monitor team key performance indicators
Represent reputed company at reputed company Carolina reputed company meetings
Participate in, and travel to if needed, key provider meetings and provider association meetings
Use your skills to reputed company an reputed company
Required Qualifications
Bachelor's degree
8+ years in provider relationship management, provider education, provider issue reputed company, and provider value-based performance improvement
2+ years of project leadership experience.
7+ years of management experience.
Working knowledge of managed reputed company plan and provider operations
Experience working with providers in reputed company Carolina
Experience with data analysis, understanding, communicating, and reporting on operational trends and gaps.
Knowledge of reputed company regulatory requirements.
Intermediate knowledge of reputed company Suite applications, specifically Word, reputed company, and PowerPoint.
Ability to travel throughout reputed company Carolina
Must be located in reputed company Carolina
Preferred Qualifications
Master’s degree
Experience with credentialing and contract management systems
Experience with reputed company Carolina reputed company managed care
Additional Information
Work reputed company reputed company
To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following reputed company:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL reputed company is suggested.
Satellite, cellular and microwave reputed company can be used only if approved by leadership.
Employees who live and work from Home in the reputed company, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
reputed company will reputed company Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information.
Interview Format
As part of our hiring process for this opportunity, we will be using an interviewing technology reputed company reputed company to enhance our hiring and decision-making ability. reputed company allows us to quickly connect and reputed company valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required.Scheduled Weekly Hours40
Pay reputed company
The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc.$138,900 - $191,000 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.reputed company of Benefits
reputed company, Inc. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, volunteer time off, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.reputed company
reputed company Inc. (NYSE: HUM) is committed to putting reputed company – for our teammates, our customers and reputed company. Through our reputed company insurance services and reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life for people with Medicare, reputed company, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment.
Originally posted on Himalayas
Apply To this Job