WellStar Health Systems Director Provider Relations - Managed Care in marietta, Georgia

Overview

At WellStar we all share common goals. That’s what makes us so successful – and such an integral part of our communities. We want the same things, for our organization, for our patients, and for our colleagues. As the largest not-for-profit healthcare system in Georgia, this means we pride ourselves on investing in the communities that we serve. We continue to provide innovative care models, focused on improving quality and access to healthcare.

Responsibilities

Leads and manages the Provider Relations team, building a strong, cutting edge foundation of standard of work, tools,

processes, and methodology to support an engaged provider network. Provides and inspires strategic and innovative

thinking among the team members and across the systems organization. Develops relationship with payors and

providers office staff, and creates a unique and differentiating provider experience.

• Establish and oversee the entire Payer Relations function including the development of work and staffing

plans, and recruiting, developing and supervising staff.

• Oversee enrollment of all WellStar providers in the PHO and Managed Care plans

• Ensure Provider Relations staff, providers and their staff understand the obligations specified in the Managed

Care contracts and that they have the information needed to effectively administer contracts

• Assist providers to resolve issues with the Managed Care payors

• Assist Managed Care payors to resolve issues with WellStar providers

• Hires, trains, coaches, counsels, and evaluations the performance of direct reports

• Understand and be knowledgeable of contract payment terms and be able to identify payment/procedural

processing errors and follow up on any discrepancies, including over and under payments.

• Leads the administrative functions for WellStar Clinical Partners

• Work closely with Clinical Integration/Population Health Management team to support patient engagement

and achievement of various incentive goals.

• Builds and manages the Employee Plan Network for the entire enterprise.

• Support Contracting team during payer negotiations by identifying key areas of payment or procedural

problems in an effort to change terms to avoid future recurrences.

• Actively participate in incentive performance strategy and results meetings. Share knowledge and experience

to support the process by creatively identifying new strategies, strengthening results of existing ones and

deleting problematic or low results initiatives.

Qualifications

Required Minimum Education:

A bachelor’s degree from a recognized college in healthcare, business, finance, or related field required. MBA or MHA strongly preferred

Required Minimum Experience:

Seven (7) to ten (10) years of experience in healthcare industry with focus on managing physician’s office, managed care department or billing office. Financial acumen and the ability to analyze claims data, open accounts receivable patient records, denial logs/reports and contract terms required. Previous experience as a functional area lead managing cross functional teams, or supervisory experience including hiring, training, assigning work and managing the performance of staff is required. Preferable to have spreadsheet and work processing skills

Required Minimum Skills:

Strong interpersonal and communication skills, understanding of managed care operational process and policy driven. Ability to build relationships with outside vendors. Ability to build strong relationships with internal customers and departments. Strong verbal and written communication skills. Able to negotiate physician contrats. Attention to detail and the efficient to independently problem solve.

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Join us for outstanding benefits and development opportunities. We also offer state-of-the-art technology, professional support and advancement, and colleagues that rank amongst the best in the country. The WellStar culture of caring has also been nationally recognized three years in a row by Fortune Magazine as one of the “100 Best Companies to Work For”. Step up to your potential. Find out more and apply today.

WellStar is an equal opportunity/affirmative action employer. All applicants are considered without regard to race, color, religion, sex, age, national origin, disability, veteran status or any status which is protected by local, state or federal law.

Department Director Provider Relations - Managed Care

Facility WellStar Shared Services

Category Leadership

City Marietta

Shift Days

State Georgia