GENERAL SUMMARY
Responsible for the daily operation and direction of the Provider Relations Department in Kentucky. Supervises employees who maintain working relationships with the existing network and assist in the recruitment of new providers. Ensures the accuracy of current provider databases relating to provider facilities and physician information. Assists with the establishment and interpretation of the department’s policies and procedures.
ESSENTIAL RESPONSIBILITIES
- Supervises all activities associated with 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 and accurate.
- Oversees the resolution of administrative problems affecting network providers, patients, and plans within contracted guidelines for which responsible. 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 plan departments.
- Performs other duties as required.
Qualifications:
JOB SPECIFICATIONS
- Bachelor’s degree or equivalent experience.
- Significant experience (usually 5+ years) with a combination of exposure to benefits interpretation and provider networking.
- Previous supervisory experience preferred.
- Substantive knowledge of managed care policy and direction.
- Knowledge of ICD-9 and CPT codes desired.
- Strong analytic and problem solving abilities.
- Strong communication and negotiation skills.
Coventry Health Care is an Affirmative Action/Equal Opportunity Employer, and we are committed to building a talented and diverse team.
Job: Professionals
Primary Location: , KY, US
Organization: 38500 - Coventry Health & Life-KY
Schedule: Full-time
Job Posting: 2012-12-10 00:00:00.0
Job ID: 1212522