To plan, direct and assure implementation of the Provider Services activities with practitioners, new healthplans, initiatives, protocols and products, which ensure compliance with contract criteria.
1)Set business strategy for Provider Services that reflects the overall goals and objectives of HCP. 2)Maintain ongoing relationships with all levels of the organization to detect provider issues and implement corrections. 3)Identify systems issues and work jointly with all departments at HCP to assure services provided to the network meet the stated expectations. 4)Plan and direct the writing and presentation of internal and external communications and ensure that all aspects are compliant with applicable contract(s).* 5)Develop and direct communication plans with other departments, educate, through in-services, both internal departments and outside providers to ensure that the overall corporate Provider services objectives are achieved, and network-wide problems are minimized.* 6)Initiate the growth and development of medical groups and IPAís as dictated by business needs and enrollment growth opportunities. 7)Develop and direct distribution of fast faxes, provider manual and other written documents to the providers within the network.* 8)Develop target provider list for inclusion in Affinity I and II.Ensure adequacy and cost containment for Professional Services. 9)Facilitate the initiation of strong, positive working relationships with physicians and their office staffs.* 10)Direct Provider Services aspects of new contracts for healthplans. 11)Direct research and make recommendations for benefits to be paid in capitated and fee for service networks. 12)Direct, manage, implement and follow through on new projects as needed.
*Essential Job Functions
Skills, Knowledge, Abilities:
∑Strong organizational and problem solving skills with bottom-line orientation. ∑Knowledge of market and industry standards as well as contract and cost management. ∑Excellent written and oral communication skills and the ability to interact with internal and external customers and vendors. ∑Proven ability to coordinate the activities of a multidisciplinary team, and to handle multiple assignments simultaneously. ∑Demonstrated superior people, and customer relationís skills to interact with physicians, and their office staffs to maintain high satisfaction. ∑Demonstrated expertise to produce results within a budget and an aggressive time frame. ∑Demonstrated self-directed results-oriented approach to projects and responsibilities in an unstructured, cutting edge, fast-paced environment. ∑Strong knowledge of MS Excel, Access and Word necessary; Powerpoint is a plus.
∑Masters degree or equivalent of in healthcare, business administration or related field preferred but not required. Knowledge of medical practice Services is a plus. ∑Higher degree preferred.
Min. 3 years senior level health care related experience with emphasis on Provider Services and Contracting, Physician Profiling, Database manipulation and reporting, Network formulation and Design.The ideal candidate also has experience in an HMO, IPA, medical group, physician management company, other managed organization or consulting firm with responsibilities for network development, physician recruitment, physician practice management, clinical duties, or combination.An automobile required for travel locally.
POSITION REPORTS TO: Vice President, Network Operations
Provider Service Representatives
The statements herein are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skill required of personnel so classified.