Provider Relations Manager

Our Organization:

Welcome to Arkos Health! We are a value-based healthcare company providing solutions for payors and providers by combining unique technology with in-home, virtual, and in-clinical care for patients. Backed by a robust technology platform, innovative software, and a light human touch, Arkos Health is committed to delivering advanced and accessible community-based services allowing our clients to live healthier, more independent lives. How do we do this? Arkos serves health plans and provider organizations by managing their highest-risk and highest-cost populations. Our goal is to be the most valued partner to health plans, service providers, and the community we collectively serve.

How You'll Make a Difference:

The Provider Relations Manager (PRM) assists in the overall success of the department. This position supervises a team comprised of Provider Relations Representatives and Coordinators. The PRM plays a critical role in ensuring high levels of provider satisfaction and will possess excellent relationship building and leadership skills.

Essential Duties and Responsibilities:

• Manages all aspects of Provider Relations to include provider relations and operations to support provider service, provider education, and product and market expansions.
• Manages Provider Relations staff in the day-to-day performance of their jobs.
• Provides weekly metrics to Director of Provider Relations regarding departmental performance.
• Monitors the efficiency of team structure and performance through analytics, processes and tools to ensure departmental goals are being met.
• Develops and trains staff to educate key individuals in provider groups regarding new approaches, products, reimbursement methodologies, appropriate coding including risk scores, quality measures and policy standards changes.
• Monitors the effectiveness and timeliness of provider communication, education, and resolution of provider concerns:
  • Ensures assigned provider offices have frequent and regular interactions with the Provider Relations team.
  • Tracks and reports on office visit activity by the Provider Relations team.
  • Identifies provider issues and follows to resolution.
    • Coordinates and tracks timely responses for provider issues involving referrals, prior authorizations, claims and credentialing issues in collaboration with the health plan; escalates issues to supervisor requiring immediate intervention.
• Conducts periodic office surveys on effectiveness of provider communications.
• Assists the Director of Provider Relations on partnering with the Education Group to conduct effective practice management programs and educational events.
• Assists the Director of Provider Relations with the health plan Marketing/Sales department with provider-specific marketing initiatives.
• Develops innovative initiatives to enhance internal efficiency and effectiveness.
• In conjunction with the Director of Provider Relations, develops and implements departmental policies and procedures. Reviews and updates departmental policies and procedures annually at minimum, and as needed.
• Works closely with Director of Provider Relations for staff failing to meet goals and expectations to create performance improvement action plans.
• Monitor and maintain monthly calendar for visitation for all Provider Relations Representatives to ensure timely input through company software.
• Assists with development, implementation, and management of community outreach strategy with network providers including a communication plan to keep them informed of current issues.
• Supports the Provider Relations Representatives in managing strong working relationships with all providers; this may include in-office visits and out-of-office meetings with provider groups as needed.

Qualifications and Skills:

• Associates degree or relevant equivalent experience.
• Prior experience with provider networks and contracting with physicians.
• Preferred knowledge of CPT, ICD, HCPCS, HCC coding; training may be available for the right candidate.
• Ability to interact with healthcare professionals.
• Current unrestricted Arizona Driver's license, reliable transportation and proof of insurance required.
• Knowledge of HMO, PPO, Medicare Risk and Indemnity products preferred; Accuracy and detail orientation (written and verbal).

Benefits:

• Employer-paid Medical premiums at no cost to you
• Employer-paid Dental premiums at no cost to you
• Employer-paid Vision premiums at no cost to you
• Employer-paid Short-Term Disability premiums at no cost to you
• Employer-paid Life Insurance premiums at no cost to you
• Employer matching 401(k)
• 15 days annual combined sick/vacation and 9 days of holiday during your first year
• Your Birthday off!

Must complete our Culture Index Survey. Take the assessment at https://go.cultureindex.com/s/bg3VS0H2kF. This is not a pass/fail test and does not measure intelligence.

Arkos Health EEO Statement:

All Arkos Health divisions are Equal Opportunity Employers. We do not discriminate on the basis of race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status or any other status protected under federal, state or local laws.

Arkos Health is a drug free workplace. All job applicants selected for employment are required to submit to a pre-employment drug test and background check.