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Supervisor, Provider Services Account Management

Company: Agilon Health, Inc.
Location: Honolulu
Posted on: February 20, 2021

Job Description:

Company or Affiliated Company:MDX Hawai'i, Inc.Location:HawaiiJob Title: ---Supervisor, Provider Services Account ManagementJob Description: ---JOB SUMMARY: The Provider Network Operations Supervisor performs support functions and supervises the Provider Network and Tricare Network Coordinators. Duties include but are not limited to performing all Provider Network Operations functions, perform training, generate reports, maintain updates used within the department and being a resource for staff as well as contact for other departments. Other tasks include responding to provider inquiries, gathering data and for appeals and grievances, and call documentation and handling. Provide support to the Provider Network Operations Manager and other departments as required. Provider Network Operations Supervisor services all provider specialties in their geographic territory on all lines of business:

  • Commercial TPA (Full Service, Reprice, and all others)
  • Medicare Advantage Plans
  • General Tricare Information
  • General Health Care Quality Initiatives TYPICAL WORKING CONDITIONS: Field based position; subject to both inside environmental conditions (temperature fluctuations of air-conditioned office) and outside environmental conditions (weather fluctuations). Subject to noise from various types of office equipment, including but not limited to: typewriters, copy machines, faxes, printers and computers. May be exposed to chemicals and/or fumes (e.g. copy toner or cleaning fluid). Incumbent will work in the office setting, provider office settings and other locations where meetings, demonstrations, evaluations and/or training sessions are performed. May require travel via own automobile or day/overnight travel to the Neighbor Islands and/or the Mainland.ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.Regularly and dependably reports to work as scheduled. Follows all Company policies and procedures, including but not limited to personnel policies, safety policies and operational policies as communicated by management. Follows all Department policies and procedures, including, but not limited to procedural guidelines/workflows, attendance requirements and performance requirements as communicated by management.In accordance with State and/or Federal confidentiality/privacy laws, maintains confidentiality of all company, provider, member and client information as specified by Company confidentiality policies and procedures. Represents the Company in a professional manner at all times when dealing with both internal and external customers. Assists in the selection and development of Provider Network Coordinators. Supervises Provider Network Operations activities. Continually coach Coordinators to ensure individual and departmental performance goals are achieved. Assists with the development and enforcement of departmental policies and procedures. Serve as point of contact for escalated issues. Coach staff regarding how to effectively resolve such issues. Participates in or facilitates internal and external meetings, as required. Liaison between Company and external vendors/customers. Researches and develops provider agreements and other contracts and establishes regular contract review. Performs contract/reimbursement support analysis in support of contract negotiations. Monitors provider network for adequate access for member population. Develops and revises provider orientation and training materials for presentation to providers and their office staff. Monitor providers as assigned for contract compliance, provides orientation, training and support as needed. Develops and writes Provider Network Operations materials for manuals, newsletters and direct mailings to providers. Represents MDX Hawai'i at health care related affairs, provider meetings, lectures or presentations as assigned. Works with providers and internal staff to resolve contract and claims issues and inquiries. Participates in the development and preparation of network provider listings, including the Preferred Provider Directory Participates in the review and analysis of fee schedules and makes recommendations for revisions. Plans and coordinates provider meetings, seminar and direct mail activities as assigned. Participates in special projects on request. Performs other duties as assigned.MARGINAL DUTIES AND RESPONSIBILITIES include the following, additional duties may be assigned. Assists in obtaining required credentialing documents from providers as needed. Assists Customer Service staff by answering Provider Network Operations ACD line as needed. QUALIFICATION REQUIREMENTS: To perform this job successfully, and individual must be able to perform each essential duty satisfactorily.-- The requirements listed below are representative of knowledge, skill and/or ability required.MENTAL, PHYSICAL AND COMMUNICATION DEMANDS: Ability to multitask and function in a high volume/busy environment. Ability to work calmly under pressure and appropriately plan, prioritize, organize and carry out tasks and responsibilities.Essential: Standing, sitting, walking, climbing stairs, hearing, speaking, twisting body, lifting/pushing/pulling usual amount of 30 lbs., reaching at or above shoulder level. Frequent: Stooping/bending, frequent gripping of an object.Occasional: Crawling, kneeling, crouching/squatting, finger dexterity, static gripping of an object for prolonged periods Good decision making and communicating skills. Ability to motivate people. Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports, correspondence and procedure manuals. Ability to speak effectively before groups of customers or employees of organization. Ability to effectively present information and respond to questions from groups of managers, clients, customers and the general public.Requires travel via own automobile throughout O'ahu. Requires day and/or overnight travel to Neighbor Islands.EDUCATION AND/OR EXPERIENCE:--EducationBachelor's degree in business or health care administration or related field or comparable education and experience.ExperienceFive years health care industry experience required. Three years experience in managed care preferred. Previous supervisory experience preferred. LANGUAGE SKILLS : Ability to read and interpret documents such as contracts, agreements and procedure manuals. Knowledge of medical terminology. Ability to write professional business reports and correspondence. Ability to speak effectively before small or large groups of customers and employees of the company. Ability to communicate effective with health care, legal and actuarial professionals. MATHEMATICAL SKILLS : Ability to add, subtract, multiply and divide. Ability to calculate figures and amounts such as discounts, percentages, interest and proportions. Ability to apply concepts of algebra. REASONING ABILITY : Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to set priorities and meet deadlines. Attention to detail and good concentration skills. LICENSES, CERTIFICATIONS, REGISTRATIONS : Current/valid Hawai'i Driver's License. Proof of Hawai'i No-Fault Auto Insurance. Clean driving record as evidenced by a recent driver's abstract (to be provided by the employee). OTHER SKILLS AND ABILITIES : Excellent PC skills Experience in Microsoft Office Window's based applications (e.g. Microsoft Word, Excel, Access and PowerPoint). Ability to travel, work nights and/or weekends as required. Posted 30+ Days Ago Full time R001030 About Us 0:00 / 2:00 PASSION & PURPOSE The passion to change the way healthcare is delivered permeates everyone and everything at agilon health . Working together we can use our expertise to make a difference in the lives of patients and physicians alike. We can bring the joy back to practicing medicine for physicians and improve the care experience for patients across the country. Equal Opportunity Employer agilon health is committed to excellence through diversity. We are an equal opportunity employer and we will not discriminate against employees or qualified applicants for employment regardless of race; color; religion; genetic information; national origin; sex; pregnancy, childbirth, or related medical conditions; age; disability; citizenship status; uniform service member status; or any other protected class under federal, state, or local law. We strive to develop leaders and build future talent pools to help us meet the needs of our customers. If you need assistance or an accommodation due to a disability, you may email us at Talent.Acquisition@agilonhealth.com .

Keywords: Agilon Health, Inc., Honolulu , Supervisor, Provider Services Account Management, Executive , Honolulu, Hawaii

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