Provider Relations Manager - Radiology

United States

Job Description

Management level position within the Radiology Network Department. Responsibilities include developing and promoting a positive perception of NIA, developing a customer oriented, collegial partnership with providers; conducting provider education and training programs for new network participants and when implementing new clients, product lines and when performance issues warrant remedial focus,; taking the lead in responding to and resolving provider issues;, facilitating problem-solving with other internal operations stakeholders and client provider relations personnel to achieve fair resolution and positive outcomes whenever and wherever possible with providers; and/being proactive in communicating with high-impact providers in each market to ensure that the highest provider satisfaction levels are achieved and client appreciation is gained as a result. The position requires excellent oral and written communication skills and professional presentation capabilities.
 
 

Essential Functions


- Assume leadership role in researching provider complaints and issues, collaborating with personnel from various internal operations areas to determine root causes in order to remedy these problems, being on point to communicate with providers throughout the course of problem resolution.
- Take the front line in establishing and maintaining strong communications with NIA providers.
- Work with Network Development to create a seamless relationship transition for new network providers passing the lead relationship role from ACMs to provider relations.
- Develop and maintain strategic and tactical approaches to relating to high-impact providers in the network that will distinguish NIA in the industry and result in peak provider satisfaction and network stability.
- Establish and maintain optimal communication channels with NIA client provider relations and account management personnel at the corporate and market levels to foster confidence in NIA’s abilities to rapidly resolve provider issues.
- Establish and maintain an effective approach to coordinating with the provider relations and network development personnel of network vendors of NIA to collaboratively educate network participants and resolve provider issues satisfactorily in vendor markets.  
- Identify opportunities for promoting broader use of RadMD and proactively communicate with providers not taking full advantage of the tool
- Identify providers not availing themselves of EDI and EFT and proactively communicate with them to transition them to these platforms.
- Conduct telephonic, web-based and onsite training sessions (individual and group) for new network participants (rendering providers) and for ordering providers during new client implementation phases.
- Conduct training sessions for clients’ provider relations and call center staffs so as to equip them with the background knowledge of NIA processes to assist in their ongoing training of their network providers.
- Routinely monitor provider performance to target and perform remedial training sessions based upon area of need (e.g., authorization processes, claims submissions, etc.)
- Special projects as assigned by management.

General Job Information

Title

Provider Relations Manager - Radiology

Grade

24

Job Family

Operations Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

2/7/2019

Date Requisition Created

2/6/2019

Minimum Qualifications

Education

Bachelors (Required), Masters

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • 5-8 years in a Provider Relations role for a managed care plan. 
  • Solid knowledge of health plan operations required.
  • Depending on assigned business unit, knowledge or experience in management of medical drug benefits, specialty pharmacy, pharmacy benefits management (PBM), behavioral health, or radiology may be required.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled