Location:
Calmont Operations BuildingDepartment:
Network MgmtShift:
First Shift (United States of America)Standard Weekly Hours:
40Summary:
Responsible for providing oversight and service for CCHP providers including the creation/implementation of: physician, hospital and ancillary provider orientation, training and ongoing educational activities for CCHP network providers and their staffs. Responsible for tracking and resolution of concerns, complaints, and issues raised by network providers, and results reporting. Develop and implement additional communications required to assure that CCHP providers are knowledgeable regarding CCHP operations and programs.Additional Information:
Responsible for providing oversight and service for CCHP providers including the creation/implementation of: physician, hospital and ancillary provider orientation, training and ongoing educational activities for CCHP network providers and their staffs. Responsible for tracking and resolution of concerns, complaints, and issues raised by network providers, and results reporting. Develop and implement additional communications required to assure that CCHP providers are knowledgeable regarding CCHP operations and programs.
Qualifications:
Bachelors Degree preferred, but will consider 10 years healthcare/provider and/or member services experience in lieu of degree.
Seven (7) years of operational experience in a managed care organization specifically in the area of provider network management, contracting and contract negotiations, claims systems, problem resolution and provider communications required.
2-4 years supervisory experience in leading and directing the work of others.
1-2 years experience working with state regulatory agencies preferred.
Knowledge, Skills, & Abilities:
Incumbent must demonstrate proven success in establishing and maintaining positive working relationships with health care providers and their staffs.
Working knowledge of HMO business operations specifically the functions of utilization management, member services, claims, credentialing and benefit plan interpretation.
Must be attentive to detail, have excellent organizational, problem solving, verbal and written skills.
Must be able to work independently and actively participate as an integrated team member.
Presenting in a public setting and public speaking is desired.
Medical billing and Healthcare industry knowledge required.
Basic understanding of CHIP & STAR benefits, and NPI/TPI relationships for billing.
Willingness to continuously improve knowledge base in both health care and provider contracting and management.
Experience with Microsoft Office Suite (Outlook, Excel, Word, PowerPoint).
About Us:
Cook Children's Health Plan
Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region. Cook Children's Health Plan provides health coverage for CHIP, CHIP Perinatal, STAR (Medicaid) and STAR Kids Members in the Tarrant county service area. The counties we serve includes Tarrant, Johnson, Denton, Parker, Hood and Wise.
Cook Children’s is an equal opportunity employer. As such, Cook Children’s offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.
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