Department:OH1CH_84730_000 MCHP Provider Contracting
Expected Weekly Hours:40
Position Purpose:At Mount Carmel, we’re committed to making a meaningful difference in the lives of our patients and communities. Our colleagues – people like you – share our passion for always going above and beyond to provide the highest standards of care
MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries in Ohio. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.
Job Description Details:
Our Provider Relations & Network Manager is responsible for a full range of provider relations and service interactions including contracting and recruitment, issue resolution and escalations, strategy development and execution, education, and retaining MediGold Contracted Providers. This position serves as the primary point of contact for the Providers and will require extensive relationship building, driving the resolution of complex issues, and MediGold brand building. The individual will also assist the Director for Provider Contracting and Network Development to develop provider collaborations that ensure network growth and quality/efficiency targets.
- Recruit providers to build a cost effective and high quality provider network within MediGold guidelines.
- Serve as the MediGold point of contact within the Provider network.
- Act as the MediGold Subject Matter Expert and brand ambassador.
- Addresses customer complaints by directly handling the issue, working with the correct department(s) to resolve, or escalating as required.
- Engage Providers to develop, coordinate, and lead training and distribution of materials.
- Proactively drive communications with Providers via telephone/email and onsite visits.
- Collaborates with the Director - Provider Contracting and Network Development to develop communication goals, strategies, and plans.
- Negotiates provider contracts within MediGold guidelines and financial standards.
- Collaborates with the Managers of Member and Provider Communications to oversee the completion of all provider communication content and materials.
- Manages and works with other internal partners to facilitate provider Joint Operating Committee (JOC) Meetings.
- Develops, implements, and manages policies, and procedures as assigned.
- Assists Director and/or Sr. Director with the Medical Delivery Systems budget.
- Manages successful implementation of provider contracts, including interpretation of payment and reimbursement terms.
- Bachelor's degree in Healthcare Administration, Finance, related field or equivalent experience.
- Minimum five years of experience with a Health Plan or Health Provider. Prior contracting and network development experience highly preferred
- Knowledge of physician claims coding and Provider reimbursement payment methodologies. Ability to interpret Provider contracts
- Establish and maintain relationships with Providers to ensure quality and satisfaction of services provided
- Capacity to address complex problems including claims issues and customer service complaints; work with other departments to achieve resolution of the issues
- Demonstrated ability to identify areas of opportunity within Provider networks for improving overall efficiency and quality
Discovering opportunities, support and excellence – all while making a real difference in patients’ lives – begins at Mount Carmel. Find a new beginning and advance your career with us.
Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, or physical ability.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.