Provider Systems Manager

Provider Relations Systems Manager

Manage daily operations of Provider Relations Systems and Data functions. Responsible for ensuring provider data is accurate and updated in several systems and databases. Provide leadership, support, and direction to the PR Systems and Data staff. Ensure the highest level of accuracy and timeliness of provider database configuration and maintenance.

Responsibilities

• Manage the daily functions of the Systems and Data staff and monitor use of Partnership systems, including but not limited to the Amisys, and SUGAR systems. Provide leadership, direction, training, support, and daily supervision to staff.
• Monitor staff productivity, accuracy, and service delivery using performance standards.
• Provide monthly performance feedback to staff.
• Monitor inventory control reports weekly and adjust staff priorities based on inventory.
• Provide Director with bi-weekly inventory and aging reports and plan for improving timeliness when applicable.
• Conduct weekly staff meetings.
• Support staff development by identifying and overseeing staff training on new duties.
• Responsible for cross training; ensuring at least two staff can perform each function.
• Monitor compliance of the PR dept. quality measures; report monthly and quarterly.
• Develop and revise department policies and procedures.
• Interview and participate in selection of PR staff that are direct reports.
• Participate in preparation and interview process for Partnership audits; internal and external.
• Act as liaison with internal Partnership departments.
• Promote a positive attitude, team work, and fun in the workplace.
• Prepare documentation and participate in special projects.
• Ensure accuracy of regulatory reports and deadlines are met.
• Monitor and ensure accuracy of reports for HEDIS, DHCS, and DMHC.
• Department lead for Partnership system workgroups.
• Track and ensure accuracy of provider data and contracts in Partnership SUGAR database.
• Coordinate activities related to Partnership systems with Claims Configuration, IT, and Finance departments.

Qualifications

Education and Experience

Bachelor's degree in related field preferred; minimum two (2) years' experience in a managed care environment in provider relations / data, claims or IT, preferred; or equivalent combination of education and experience. Experience with provider networks, including consolidations and setting up contracts in systems preferred.

Special Skills, Licenses and Certifications

Knowledge of Amisys or similar managed care processing system. Understanding of provider data, provider payments and how changes impact systems and outcomes. Working knowledge of business software applications. Knowledge of managed care concepts, policies and procedures. Must have access to own reliable vehicle. Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business.

Performance Based Competencies

Excellent oral and written communication skills. Excellent organization skills with the ability to prioritize assignments, maintain accurate records, and meet deadlines. Ability to use good judgment in making decisions within scope of authority and to handle sensitive issues with tact and diplomacy.

Work Environment And Physical Demands

Ability to use a computer keyboard. More than 30% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 35 pounds.

All HealthPlan employees are expected to :

HIRING RANGE :

$103,059.95 - $133,977.94

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.