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Aetna is now a CVS Health Company

Supervisor, Provider Relations

Primary Location: Richmond, VA
Additional Locations: VA-Richmond
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Description:
Responsible for the daily operation and direction of the Provider/Network Relations consultants and representatives. Supervises and trains employees who maintain working relationships with the existing provider network and assist in the recruitment of new providers. Ensures the accuracy of current provider databases relating to provider facilities and provider information. Assists with the establishment and interpretation of the department’s policies and procedures.

Fundamental Components:
  • Leads a team of provider/network relations consultants and representatives to ensure the establishment and continuous updating of provider databases and provider documentation; ensures the provider data entered into the database is accurate and that the provider documentation is complete.
  • Oversees the resolution of administrative problems affecting network providers, patients, and Plans within contracted guidelines; resolves problems and advises providers of new protocols, policies, and procedures.
  • Provides oversight of provider claims issues; coordinates and communicates resolution.
  • Negotiates, reviews, and prepares draft agreements with alternative delivery system facilities, laboratories, and group practices.
  • Assesses departmental and provider training needs; develops and implements appropriate training programs.
  • Coordinates provider status information with member services and other internal departments.
  • Performs other related duties as required
  • Required to communicate w/internal/external parties by phone/in person; may require travel to offsite locations


Background Experience:
  • Minimum of 3-5 years recent and related experience in benefits interpretation and provider networking.
  • Supervisory experience a plus.Knowledge of ICD-9, ICD-10 and CPT codes desired.
  • Excellent analytical and problem solving skills
  • Strong communication, negotiation, and presentation skills.
  • Undergraduate degree in a closely-related field or an equivalent combination of formal education and recent, related experience.


Additional Job Information:
This position will be a working supervisor, with the ability to work collaboratively with other teams within the Provider Experience model. Serve as a mentor to the team. Have the ability to present team's metrics and progress on Operations calls and other meetings.

Required Skills:
General Business - Demonstrating Business and Industry Acumen, Leadership - Collaborating for Results, Leadership - Engaging and Developing People

Desired Skills:
General Business - Communicating for Impact, General Business - Ensuring Project Discipline, Service - Working Across Boundaries

Functional Skills:
Network Management - Provider relations

Potential Telework Position:
No

Percent of Travel Required:
10 - 25%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Click To Review Our Benefits (PDF)

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