Manager Provider Network

Job Description

Job Description

Positiion Summary:

The Manager Provider Network supervises the APS Provider Department operations, pertaining to credentialing, re-credentialing, provider data systems, contracting document production, provider negotiations and provider education. This key individual streamlines processes for better integration of the credentialing functions, while maintaining proper database management and report elaboration. The Manager Provider Network elaborates and establishes contracts, fee schedules and all communications related to the Provider Department.

Essential Functions:

1. Supervises the credentialing and re-credentialing processes, and ensures compliance with State and Federal regulations, contractual requirements and applicable accreditation organizations.
2. Negotiates with provider’s service fees, per-diem rates and contract terms, to provide services to APS beneficiaries.
3. Ensures[BM1] that provider credentialing information is entered accurately within the electronic systems and actively updates directories.
4. Produces and maintains monthly provider reports.
5. Elaborates implements and maintains the Provider Operations Department policies and procedures, in compliance with CMS, NCQA, URAC standards.
6. Serves as liaison between providers, clients and internal personnel to ensure that service expectations are met.
7. Elaborates and implements training and education for new personnel focused on specifics of the Provider Operations Department.

Education:

• Bachelor’s degree in Business Administration or related field.

Experience:

Minimum 4 years of experience as a Provider Relations Supervisor/Representative or a position related to the health industry preferred.

Knowledge:

• Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level preferred.