Managed Care Provider Relations Specialist

UNM Medical Group, Inc is hiring a Provider Relations Specialist to join our Office of Managed Care and Clinical Contract Services Team.

The Provider Relations Specialist will be responsible for or maintaining positive relationships with operational departments, Managed Care Organizations and other entities, handling escalated issue management and dispute resolution activities; and serving as a primary liaison to provide communication, education, issue resolution and support to UNM Health System.

Summary

Reporting to the Managed Care Director, the incumbent will be responsible for facilitating third party payer relations; tracking and resolving operational, administrative, financial and clinical issues related to managed care contracts affecting UNM Hospitals, UNM Medical Group, UNM Cancer Center; oversight of operational meetings with UNM and third party payers; processing of various managed care contracts.

Minimum Job Requirements of a Provider Relations Specialist:

High school diploma or GED with 2 years directly related experience. Verification of education and licensure (if applicable) will be required if selected for hire.

Duties and Responsibilities of a Provider Relations Specialist:

1. Acts as primary point of contact among parties to address operational, administrative, financial and clinical issues affecting UNM providers, UNM Hospitals and third party payers. Works effectively with all internal and external parties to resolve contractual issues in a timely manner.
2. Initiates and facilitates joint operating committee and other operational meetings with managed care organizations to resolve issues and provide timely follow up. Responsible for drafting meeting agendas and minutes.
3. Maintains a comprehensive database to track and manage identified issues; analyzes data and generates reports.
4. Establishes rapport and maintains positive working relationships with UNM constituencies and managed care organizations; meets routinely with internal and external constituents to review issues and facilitate customer service.
5. Identifies, analyzes, and evaluates contractual compliance issues; resolves or facilitates resolution of compliance-related problems among constituencies, as appropriate.
6. Manages system of third party payer mail distributions and disseminates other pertinent information to UNM providers and billing staff.
7. Processes single case rate agreements; tracks payments and provides follow-up.
8. Works with managed care contract officers to provide contract support, contract tracking, database management and other facets of contract management.
9. May respond to, initiate, and evaluate requests for managed care contracts for multiple product lines and venues; makes recommendations to leadership on appropriate course of action.

10. May identify and reports any situations or issues regarding current providers that may have potentially adverse implications with respect to Medicare/Medicaid reimbursement; recommends courses of action to be taken and coordinates action with interested department.

11. May troubleshoot and resolve problems as they arise related to Medicaid enrollment and complete Medicaid Turn Around documents, licensure expirations and other requirements as needed.

12. Participates in development, implementation and maintenance of policies, objectives, and short-and-long-range planning; develops and implements projects and programs to assist in accomplishment of established goals.

13. Remains abreast of current and emerging issues related to the national, state, and local health care market, administrative practices, privacy, compliance and/or government rules and regulations.

14. Performs miscellaneous job-related duties as assigned.

About Managed Care and Clinical Contracting Services:

The Office of Managed Care and Clinical Contract Services Team consist of multiple teams that service the entire UNM Health System with contracting, value based care, and credentialing/provider enrollment.

The successful incumbent must have the ability to work independently with minimal supervision and coordinate multiple duties at a time in a fast-paced working environment with changing priorities.

This role requires someone who demonstrates a high degree of professionalism and the ability to communicate efficiently.

About UNM Medical Group, Inc:

UNM Medical Group, Inc. (UNMMG) is the practice plan organization for physicians and other medical providers associated with the UNM Health Sciences Center. UNMMG is a New Mexico non-profit corporation and is an equal opportunity employer. UNMMG strives to mitigate health disparities brought about by technology; we aim to reach underrepresented populations, making healthcare more equitable and accessible for all of the people in New Mexico; we have a demonstrated commitment to diversity, equity, inclusion, and student success as well as working with broadly diverse communities.

Benefits:

UNMMG offers a competitive salary and an attractive benefit package which includes medical, dental, vision, and life insurance as well as tuition assistance, generous paid time off plan and 403b retirement for benefits eligible employees.

Apply to our Provider Relations Specialist opportunity with UNM Medical Group, Inc. and a recruiter will contact you shortly!