AVP Provider Relations - (US-OH-Cincinnati - 45999)

Minimum Education: Tech School
Job Type: Full Time
Jobcode: 1740977
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Responsible for providing the Health Plan with expertise in physician, physician group, hospital and ancillary healthcare contracting and provider reimbursement methodologies, taking the lead or assisting on Provider Relations projects in existing, expansion and new markets. Works with senior management to develop contracting and financial strategies, execute strategies, and maintain positive provider relationships while advancing the goals of the Health Plan. Responsible for oversight of Provider Relations staff and servicing activities, including resolution of complex operational issues impacting provider relationships.

PRIMARY RESPONSIBILITIES:
1. Assist Health Plan senior staff in interacting and negotiating with the provider’s most senior clinical and administrative executives.

2. Collaborate with the CEO/COO and other Health Plan senior management to determine the Plan’s provider contracting needs.

3. Work with Health Plan CEO/COO and other appropriate senior management in the development of provider network business plans, strategies and goals as they relate to network expansion and provider contracting, education, communication, policies, procedures and servicing.

4. Work with Plan senior management to develop provider network related earnings improvement initiatives as well as network growth and expansion initiatives.

5. Develop and implement Provider Relations projects or assignments in support of Health Plan goals and the Home Office.

6. Support Health Plan CEO/COO in the strategic analysis and negotiation of all types of complex Provider contracts.

7. Review financial information and, in collaboration with Medical Finance and other corporate departments, develop effective reimbursement methodologies and strategies to achieve specific contracting and budgetary objectives which are operational and efficient.

8. Monitor local market trends relative to provider contracting, reimbursement and service, make recommendations to modify current processes and assist implementing changes when necessary.

9. Educate Provider Relations staff on the concepts and practice of provider marketing. Assume responsibility for development, implementation, operation and oversight of provider marketing efforts in collaboration with Sales and Marketing leader.

10. When provider issues become escalated, work with senior management to interact with provider senior administrators, set strategy for issues resolution and monitor progress of issues.

11. Work with staff to identify operational issues and implement projects to promote payment of claims on first submission.

12. Supervise the provider network and operations staff to ensure proficiency and efficiency in meeting all Health Plan strategic and operational goals, MJOs and planning goals.

13. Develop and implement strategies to recruit and retain the highest quality staff members.

14. Provide coaching and direction to department directors and other direct reports.

15. Other tasks as assigned.

JOB REQUIREMENTS: EDUCATION AND EXPERIENCE:
Education
Required:
- Bachelor’s degree in business administration, healthcare administration or related field

Preferred:
- Master’s degree

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http://www.applyhr.com/14470559