Supervisor, Provider RelationsPrimary Location: Richmond, VA
Additional Locations: VA-Richmond Apply
- 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
- 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.
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