Must be a strategic thinker, excellent writer, clear and concise communicator. Masters Degree, preferred, Minimum of five (5) years progressively responsible work experience to include a minimum of three (3) years experience in managed care, insurance or healthcare environment, required, A minimum of 2 years experience in general healthcare, administrative support services, provider and customer service work environment, Equivalent work experience in health care, insurance or credentialing as a substitute to professional degree is acceptable, A bachelors degree in health care administration, business administration or related area, Education: Bachelors Degree or equivalent combination of education, training, and experience may substitute for education requirements, Experience: Experience in provider relations, information systems. Must have strong analytical abilities. This way, you can position yourself in the best way to get hired. Business Relationship Manager Cover Letter Example Experience working with computers in Windows environment preferred, Conducts ride-alongs with Reps. in the field to develop skills and behaviors and document progress/provide formative feedback through timely and consistent Field Trip Reports, Must be able to travel up to 50% in assigned market, Preferred a Bachelor's Degree in a related field, Intermediate ability to lead/manage others, Advanced knowledge of healthcare delivery, Strong functional and technical knowledge of healthcare delivery, Advanced ability to influence internal and external constituents, Advanced knowledge of CMS and state regulations, May oversee work activities of other supervisors, Product, service or process decisions are most likely to impact multiple groups of employees and / or customers (internal or external), Leading Joint Operation Committee with network providers, Day to day interactions with the provider network, Monitoring and ensuring compliance with regulatory requirements, 3+ years of provider relations and / or network management experience, Advanced level of proficiency with MS Word, Excel, and Access, Advanced level of knowledge of claims / systems processes, contracting and reimbursement methodologies, 6+ months of work or educational experience with interpreting and summarizing large data sets to drive informed actions, 6+ months of work or educational experience sourcing data, and analyzing, trending and producing a forecast from findings, 6+ months of Microsoft Excel experience working with Pivot Tables, v-lookup, sumif etc, Bachelor's Degree (or higher) in healthcare, business or other related field, Professional experience in operations, workforce management or data analysis, Professional experience in data modeling, trending and forecasting, Responsible for coordinating large scale mailing activities for the distribution of provider media materials, publications, amendments, provider manual updates. Ensure demographic information for providers and facility POCs are accurate in their assigned area. Works with presenters and other stakeholders in advance of meetings to ensure content of meeting materials is complete and supports driving to consensus and decision-making on important topics, In collaboration with field network teams, design and execute major projects related to provider engagement and network solutions, including but not limited to continued evolution of Companys Provider Engagement Model, Provider Contract Automation project, and Practice EMR Connectivity, Oversees all standard KPIs and metrics related to value-based contracting and strategic network solutions (e.g. Provider Relations Manager Cover Letter | Top Writers In this guide, we will teach you 5 key steps for writing a client relationship manager cover letter. diploma; college level education completed or in progress preferred but not required if candidate demonstrates strong aptitude, Health insurance or managed care industry knowledge beneficial, Advanced written and oral communication skills required, PC skills required, including MS Office applications such as Word, Excel, PowerPoint and Outlook, Ability to multi-task and prioritize work assignments, Ability to adapt to change; accountable in team work environment is essential. Manager Provider Relations Resume Example - LiveCareer Relationship Manager Cover Letter Examples Relationship Managers are usually employed by the financial or banking sector to cultivate relationships with clients and explain services provided to them. A professional essay writing service is an instrument for a student who's pressed for time or who doesn't speak English as a first language. Works closely with Network Education and Media Specialist in developing content for articles, Schedules project meetings and venues. Manager, Provider Relations, to Current Aetna Inc. - Henderson, KY, Responsible for Network Management, Provider Relations, Credentialing and Provider Data Management for all geographic areas. Keep reading to learn all about: 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, Familiarity with all Microsoft Office programs with experience using Outlook task management tools, Working knowledge of Medicaid, Medicaid Manage Care and or Health Plan Managed Care, Excellent communication skills verbal and written, Excellent bilingual public speaking skills, Organizational, multi tasking, and time management skills, Proven success in contributing to an individual and team oriented environment, Excellent leadership, communication written and oral and interpersonal skill, Must be able to travel within the designated region, as well as to the central Accenture location in Austin as requested by Leadership, Independent thinking, problem resolution with strong organizational capabilities, Proven ability to exercises judgment within defined procedures and practices to determine appropriate action, Minimum of 1 year Medicaid, Medicaid Managed Care and or Health Plan Managed Care experience, Telephonic outreach to providers, conveying key program messaging, Meets compliance criteria following established guidelines, Achieves successful completion of visit based upon rigorous time frames, Thoroughly documents and follows up as applicable, Communicates to designated customers following protocol, Schedules travel to achieve maximum efficiency based upon assigned visits, Represents Accenture professionally and creates a positive reflection to providers Meets established quality metrics, Collaborates with leadership and team to meet established goals and maximize efficiencies, Working knowledge of Medicaid, Medicaid Managed Care and or Health Plan Managed Care, Excellent communication skills verbal and written Microsoft Products, Ability to self-monitor, follow directions and meet deadlines, 1) Lead the development and management of provider relationships throughout the state, including both regionally important providers as well as broad network of independent clinics and hospitals, 2) Direct a statewide staff of contract managers. Ensure demographic information and facility POCs are accurate by verifying during each provider/facility contact, to include checking the box in Jenks and adding the date verified.Enter and update notes on all providers in Jenks database. Develops credentialing policies and procedures and ensures compliance with state and federal regulations, Performs site visits; and investigates provider issues to resolution. Provider relations representative Cover letter Sample | CV Owl Resource Based Relative Value System (RBRVS), 1+ years of experience in fee schedule development using actuarial models, 1+ years of experience utilizing financial models and analysis in negotiating rates with providers, At least an intermediate level of knowledge of claims processing systems and guidelines, 1+ years of experience in performing network adequacy analysis, Strong interpersonal skills, establishing rapport and working well with others, Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer, Resolves provider issues by interfacing with HCP central departments (Contracting, Eligibility, Claims and Finance), Reports systemic operational issues to the management team, Coordinates provider outreach for the CCR, Follows up with Payor Contracting department on status of clinicians being added, terminated as well as open / closed panel status based on health plan website and submitted information, Verifies annually the single / dual affiliation status of physicians and follows up when they are not maintaining this status, Serves as a point of contact to central departments for issues related to the network, communicates relevant information from the central departments to the network and provides communications and documents upon request, Makes outreach and follow up phone calls to physician offices related to specific initiatives or meetings (i.e. Analyze and make decisions regarding provider contracting in existing service areas, including decisions to contract, decisions not to contract, and at what unit cost within defined parameters, Support medical management through negotiation of spot contracts for non-participating providers, Make presentations to provider groups and communicate directly with provider group representatives regarding policies and procedures, and provider based initiatives, Cultivate and maintain collaborative internal and external business relationships, Provide support to internal and external customers, Work collaboratively with individuals responsible for delegation oversight to assure accreditation and regulatory compliance standards are consistently met, In conjunction with medical management team, identify any areas of concern regarding medical cost targets and develop action plans related to those areas, Follow up on new leads and referrals resulting from field activity, Prepare presentations, proposals and contracts, Develop, maintain and distribute provider materials, including website content, Maintain current product knowledge including an understanding of the competitive environment, Communicate new service opportunities, special developments, information, or feedback gathered through field activity to appropriate company staff, Provide support to marketing events such as seminars, trade shows, and telemarketing events, Proficient in use of Microsoft Outlook, Word, Excel, and Powerpoint and strong analytical skills, Aptitude for developing and delivering presentations, Ability to use strong interpersonal and communication skills to persuade and influence others, Ability to create, compose, and edit written materials, Demonstrated creativity in development of materials, communications, and problem solving, Maintain a professional appearance and provide a positive company image to the public, Significant local travel to current and potential provider locations requires possession of a valid state drivers license and a reliable vehicle, Demonstrated understanding of provider delivery systems, contracting strategies, reimbursement systems, Solid working knowledge of Medicare policies, programs, and procedures, and previous experience working with Medicare contracts is preferred, Willingness to work a flexible schedule and occasional overnight travel, Works collaboratively with Sales and Solution Management to lead the development of client specific solutions that result in positive outcomes, Serves as the Engagement Manager on specific client accounts, taking complete responsibility for client outcomes, Develops sustainable business strategies and ensures they are implemented to meet company goals, Preferred candidate will have a combination of a client-service orientation combined with a demonstrated ability to assimilate and lead in a high-growth entrepreneurial environment, Strong management and leadership skills and will lead by example, motivating through intellect and experience, Experience in building and leading a team for success in the marketplace and operating in a high energy environment, Strong oral/written communication, organization and interpersonal skills, combined with effective negotiation skills and a demonstrated effectiveness in a managerial role are required, Deep understanding of the buying process and unique healthcare needs of either employer / union purchasers or providers (e.g., health systems) is required, Demonstrates industry knowledge and emerging thought leadership and expertise and shares that knowledge with the team and clients, 5+ years client operations experience within the healthcare sector, account management for vendors serving healthcare clients, or similar experience related to technology-enabled solutions is required, Masters degree in business or healthcare field is preferred, Bachelors degree in business-related or fitness discipline or equivalent additional experience, Two years or more working in healthcare or fitness-related field is required, Fitness center management/operations and network development highly desired, Effective public speaking and presentation skills, Strong time management and organization abilities, Willingness and ability to travel (up to 30%), Able to handle multiple and changing priorities in a fast-paced environment, Proficient in Microsoft Office products (Word, Excel, PowerPoint, Outlook), Proficient in the use of the Internet as a communication tool and research resource, Bachelor's degree in Business Administration or related field preferred, Two to three years experience working in health care contracting managed care environment preferred, Two to three years experience working in physician practice management or a clinical setting preferred, Knowledge of health care and managed care contracting. - Instantly download in PDF format or share a custom link. responsible for scheduling, call volume monitoring and adjusting, determining and communicating work schedules and resources for call queues, consulting with call operations, etc. local and state licensing organizations), Execute basic design tasks such as newsletter layout, PowerPoint slide maintenance, and document formatting, Build solid vertical relationships, establishing a consultative role with many internal divisions to create effective communications, Create and execute communication strategies and plans for defined results, Responsible for writing, analyzing, and distributing reports; developing presentations; responding to contract needs; assisting with communications related to implementations; writing and maintaining complex documents, Communicate regularly with internal and external stakeholders using email, webinar, and in-person meetings to educate and collaborate on projects, Perform other duties as necessary for Marketing and Communications, Solid knowledge of design and writing principles, Solid organizational, administrative, analytical, written, presentation, and communication skills, Familiarity with software such as Microsoft Office Suite and Office 365 (Outlook, Project, Visio, Word, Excel, PowerPoint, SharePoint), Cisco WebEx, Adobe Creative Cloud (InDesign, Acrobat X Pro), WordPress, and Constant Contact is preferred, Solid knowledge of web-based content management systems, Editing experience in an online environment, Sets goals for their area and works closely with Managers/Representatives to drive performance and to ensure provider satisfaction metrics are met or exceeded, Conducts field rides with Provider Relations Representatives to gauge their performance and provide coaching and development in order to improve the business results, Plans, conducts and directs provider contracting/negotiations and provider servicing, Develops practices to assist risk partners in managing financial risk, Performs data analysis and develops specific actions to manage medical cost trends, Plans, provides resources and directs activities, network development, provider contracting/negotiation and provider service functions, Develops provider contracting and service strategies and ensures maximum efficiencies in the utilization of human and financial resources, Strategizes for membership growth, retention, and to affect sophisticated or complex provider relationships, Maintains compliance for State and CMS audits, Required 7+ years of experience in provider relations or similar background, Intermediate Demonstrated leadership skills, Intermediate Other Provides proactive approach and support to emerging business activities established to remain competitive in the marketplace, Intermediate Other Ability to convert related activities into a comprehensive work plan, Assist in the delivery of innovative training initiatives/materials, Provide recommendations based on observations and feedback received, Establish and maintain strong communication channels and relationships with field staff, Maintain confidentiality relative to organizational strategies, objectives, and provider reports, Assure that all responsibilities are performed consistently with the deliberate plans of the organization, Field and follow-up on Provider Relations complaints in a timely manner and follow up on designee assignments, Review claims to identify root cause and create cases to facilitate claims activities, Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable, and defined in the Universal American Corporate and department policies, Assist in the oversight of Home Health including assisting with authorizations and care conferences, Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas, Decision-making skills with the ability to investigate and weigh alternatives and select the course of action that provides the greatest benefit to the organization, Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time, Problem solving skills with the ability to look for root causes and implementable, workable solutions, Interpersonal skills with the ability to work in a fast-paced environment and participate as an independent contributor with little supervision or as an active team member depending on the situation and needs, Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization, RN with current state appropriate licensure with at least five years' nursing experience in an acute or managed care setting (unrestricted clinical license), Minimum 5 years previous supervisory experience that includes Quality Assurance, Care Coordination or Utilization Management experience, Maintains a valid driver's license for any required facility on-site and home visits, Experience in identifying organizational needs and developing programs to address those needs, Successful record of accomplishment in working independently and in a team environment, Holding final responsibility for parent and provider satisfaction relating to all tuition assistance policies and procedures as well as the data and enrollment system, Monitoring the development, rollout, and performance of the third-party-developed data and enrollment system and managing the relationship with the vendor developing and maintaining the system, Participate in hiring of team members and managing team performance, Ensuring successful operation of the tuition assistance process, including confirming provider and child eligibility and contracting, Ensuring providers seeking tuition assistance satisfy compliance requirements, Ensuring the team handles low daily volume of incoming calls from families and preschools in a professional, customer-friendly, and timely manner, Ensuring team members make outbound calls to families and preschools to follow up on pending attendance records/applications, Handling issues that are escalated by the team, Interacting with program partners on a regular basis either in person, via phone, or via email, Ensuring team members properly assist parents and preschools in multiple phases of the application and enrollment process in a timely manner, Coordinating with the Quality Improvement Manager to smoothly transition providers from 2 stars to 3 stars on the state SUTQ rating scale, Coordinating with the Finance Manager to collect data for reports to the State and coordinating with the third-party program Evaluator, Serving on Cost of Quality Wages committee, a group convened to develop the policies that will govern CPP funding that will go towards ensuring preschool providers receive a living wage, Bachelors degree; ideal candidates will have a degree relating to early childhood education or a related field, At least five years previous experience in the education space, ideally in early learning.
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