Develops and maintains provider relationships within states TriWest is responsible for direct contracting. Manages network development and supervises network contracting staff in region. Develops hospital, physician and ancillary service agreements, ensures adherence with government operational manuals, monitors network shortfalls, and resolves access issues throughout the assigned region. Facilitates resolution of escalated provider issues, and promotes TriWest Corporate initiatives.
• Provides legendary service and support to maintain strong relationships with internal and external customers.
• Develops negotiation strategies for and provides leadership to team to achieve department performance metrics.
• Monitors network to ensure adequacy is being achieved and institutes corrective actions to address shortfalls in network
o Monitors and ensures resolution of routine and escalated provider issues
o Communicates information regarding market needs, competition, and industry trends to management team.
o Provides training and development to team members.
o Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement.
o Maintains client confidence and ensures confidential information is protected.
o Works with Provider Services leadership to accurately assess network provider needs within assigned region and establish strategies to achieve them.
o Proactively manages provider networks in assigned areas and functions as primary internal spokesperson on network issues.
o Periodically visits network providers to inform partners about progress towards agreed-upon goals and upcoming network enhancements; coordinates account planning and maintenance issues.
o Provides development and training to Network Providers on changes and updates to TriWest processes and policies.
o Monitor productivity, quality and quantity of work performed by staff related to provider contracting.
o Demonstrate and maintain current knowledge of all programs, contracting, credentialing, reimbursement and operational policies and TriWest initiatives, operations, and goals.
o Reviews systems/work flow processes and procedures to identify/recommend opportunities for productivity and process improvement
o Collaborate closely with other department leadership, staff, and executive leadership on process improvement to promote service level improvements or facilitate new processes
o Head or participate in projects and committees assigned by Director or Vice President.
o Performs other duties as assigned.
o Regular and reliable attendance is required.
Education & Experience
o Bachelor's degree in Business, Health Care Administration or equivalent experienceo 8+ years experience in a managed care environment that includes provider contracting and negotiation experience within multiple states and/or territories• 5+ years management experience in the healthcare industry
o Experience in provider contracting for government programs and/or commercial lines of businesso Experience in management/supervision of provider contracting staff in a managed care environmento Experience in utilizing a contract management system to manage contracting workflow• Familiarity with Medicare payment and claims processing rules
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