Build your Career. Make a Difference. Presbyterian is hiring a skilled Provider Network Management Relations Executive to join our team.
Type of Opportunity: Full time
Job Exempt: Yes
Job is based: Reverend Hugh Cooper Administrative Center
Work Shift: Days (United States of America)
Responsibilities
Presbyterian Healthcare is seeking a Provider Network Management Relations Executive.
Some key responsibilities include:
Collaborates and maintains relationships with providers and staff throughout Presbyterian to ensure an exceptional provider experience.
Develops and maintains cooperative working relationships between PHP, institutional provider and individual providers.
Provides education on quality initiatives, managed care, capitation, products, policies and procedures, reimbursement issues, referral/authorization process, etc.
Responsible for ensuring provider data integrity and accuracy by ensuring PIF s are completed timely and accurately and through a comprehensive review and validation of provider directory data.
Responsible for post payment validation of assigned providers to ensure accuracy of payment to the contract and corresponding fee schedules.
Resolves provider issues - claims, health services, finance, etc.
Stimulates and fosters professional development of the Network Relations Service Associates.
Supports Network Contracting strategies in an effort to preserve a robust provider network.
Serves as primary liaison between the provider and the health plan.
Maintains a general knowledge of health plan reimbursement methodologies.
Conducts provider visits based on established departmental goals, which will require 50-65% field contact.
Engages and supports leadership and peers by promoting and participating in department initiatives and being accountable for achieving business objectives
Requirements
Education:
Essential:
High School Diploma or GED
All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
Wellness
Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
About Presbyterian Healthcare Services
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services
Benefits
Health insuranceDental insuranceVision insurance
Additional Information
Location Address:
9521 San Mateo NE
Albuquerque, NM 87113-2237
Compensation Pay Range:
Minimum Offer $53,768.00
Maximum Offer $82,076.80
Now Hiring: Provider Network Management Relations Executive
Phsorg · Reverend Hugh Cooper Administrative Center