Member and Provider Relations Director
Company: Prime Healthcare
Posted on: November 18, 2022
Prime Healthcare is an award-winning health system headquartered
in Ontario, California. Prime Healthcare operates 45 hospitals and
has more than 300 outpatient locations in 14 states providing more
than 2.6 million patient visits annually. It is one of the nations
leading health systems with nearly 50,000 employees and physicians.
Fourteen of the Prime Healthcare hospitals are members of the Prime
Healthcare Foundation, a 501(c)(3) not-for-profit public charity.
Prime Healthcare is actively seeking new members to join our
corporate team!Director Essential Duties and Responsibilities:
- Strengthens relationships with providers and members.
- Leads all aspects of Provider Relations to include provider
relations and operations to support provider service, provider
education, and health plan.
- Demonstrates an in-depth knowledge of the provider
- Leads, develops, and trains staff to educate key individuals in
provider groups regarding new approaches, reimbursement
methodologies, appropriate coding and where to submit claims.
- Creates efficiencies for offices decreasing the administrative
obstacles and assists in developing educational programs for
internal staff, members and providers.
- Ensures effective and timely provider and member communication,
education and resolution of provider concerns:
- Ensures assigned provider offices have frequent and regular
interactions with the Provider Relations Team.
- Identifies provider issues and follow to resolution.
- Coordinates timely responses for provider issues involving
referrals, prior authorizations, claims and contracting rate issues
in collaboration with the health plan.
- Conducts periodic office surveys on effectiveness of provider
communications and surveys with HR on effectiveness of member
- Assist health plan Marketing department with provider-specific
- Develops and implements a community outreach strategy with
network providers including a communication plan to keep them
informed of current issues.
- Develops strong relationships with outside partners, such as
vendors and advisors, as well as internal partners, including
department supervisors and co-executives.
- Responsible for Provider Relations Team in managing strong
working relationships with all providers; this may include
in-office visits and out-of-office meetings with providers.
- Develops innovative initiatives to enhance internal efficiency
- Formulates training programs for the Provider Relations
- Maintains efficient team structure and performance through
analytics, processes and tools; maximizing new provider and member
engagement; and working with the leadership team to develop plans
to meet future needs.
- Manages Provider Relations and Representatives and redirects
activities as necessary.Qualifications/Skills:
- Bachelors degree or equivalent experience in Business
Administration, Healthcare Administration, or related field.
MBA/MHA preferred. 5+ years of experience in customer service and
provider relations in a health care or managed care
- Previous management experience including responsibilities for
hiring, training, assigning work and managing performance of
- Strong interpersonal and collaborative skills.
- Demonstrated experience and knowledge of contracting
- Experience working in a consensus building and matrix
environments a plus.
- Previous health plan and provider representative experience
preferred.We are an Equal Opportunity/ Affirmative Action Employer
and do not discriminate against applicants due to veteran status,
disability, race, gender, gender identity, sexual orientation or
other protected characteristics. If you need special accommodation
for the application process, please contact Human Resources. EEO is
Prime Healthcare Management Inc ID: 2022-103445 External Company
URL: primehealthcare.com Street: 3480 E. Guasti Road Shift: Days
Exempt / Non-Exempt: Exempt
Keywords: Prime Healthcare, Ontario , Member and Provider Relations Director, Executive , Ontario, California
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