Supervisor, Provider Services Account Management
Company: Agilon Health, Inc.
Posted on: February 20, 2021
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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