UNM Medical Group
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Senior Provider Relations Specialist-Managed Care
at UNM Medical Group
UNMMG Office of Clinical Contract Services (OCCS)
# of Openings:
Job Code/Title: B5009/ Senior Provider Relations Specialist - Managed Care
FLSA : Exempt
BEST CONSIDERATION DATE: OPEN UNTIL FILLED
UNM Medical Group, Inc. (UNMMG) is the practice plan organization for physicians and other medical providers associated with the UNM Health Sciences Center. UNM Medical Group, Inc. is a New Mexico non-profit corporation and is an equal opportunity employer. UNMMG offers a competitive salary and an attractive benefit package which includes medical, dental, vision, and life insurance as well as tuition assistance, paid leave and 403b retirement for benefits eligible employees.
Negotiate and manage contract relationships on behalf of the UNM Health System which includes the UNM School of Medicine, UNM Hospitals, UNM Sandoval Regional Medical Center, and UNM Medical Group, Inc., with a variety of managed care organizations. Contracts include facility, medical group and ancillary agreements. This position will also be responsible for helping to resolve operational issues that involve these contracts.
The following statements are intended to describe, in broad terms, the general functions and responsibility levels characteristic of positions assigned to this classification. They should not be viewed as an exhaustive list of the specific duties and prerequisites applicable to individual positions that have been so classified.
Reporting to the Managed Care Contracts Director, the Senior Provider Relations Specialist is responsible for negotiating complex hospital, medical group and ancillary contracts with a wide variety of managed care organizations and third party payers. Manages contract development and implementation, and coordinates contract maintenance through the resolution of operational, administrative and clinical issues among stakeholders.
Duties and Responsibilities
- Reviews, negotiates, writes, and processes complex clinical contracts for a wide variety of managed care organizations.
- Establishes rapport and maintains working relationships with current and potential managed care organizations and constituencies.
- Identifies, analyzes, and evaluates contractual compliance issues; resolves or facilitates resolution of compliance-related problems among constituencies, as appropriate.
- Responsible for handling escalated claims/operational issues and taking action to assure timely resolution of provider issues.
- Responds to, initiates, and evaluates requests for managed care contracts for multiple product lines and venues; makes recommendations to leadership on appropriate course of action.
- Serves as an expert resource to internal and external constituents with regards to managed care contracting, development, implementation, and maintenance.
- Provides consultative support to leadership in the review and evaluation of existing managed care contracts; makes recommendations regarding contract retention or termination, as appropriate.
- Remains abreast of current and emerging issues related to the national, state, and local health care market, contracting practices, privacy, compliance and/or government rules and regulations.
- Provides leadership and assistance to the Provider Relations staff through supervision and coordination of daily operations. Acting as point of contact for all team deliverables.
- Performs miscellaneous job-related duties as assigned.
Minimum Job Requirements
Bachelor's degree with at least 2 years of experience that is directly related to the duties and responsibilities specified; OR Successful completion of 60 college-level credit hours with 4 years of directly related experience. Verification of education will be required if selected for hire.
Knowledge, Skills and Abilities Required
- Ability to develop tactical plans, and prioritize and organize projects to meet deadlines.
- Analytical and problem solving skills; excellent verbal and written communication skills.
- Ability to provide responsive customer service and follow through.
- Knowledge of MCO contracts, provider reimbursement models and contractual language.
- Knowledge of contract negotiation process with a managed care organization and an integrated healthcare system.
- Organizational skills, interpersonal skills, and the ability to manage multiple projects simultaneously.
- Ability to build and maintain strong business relationships with internal and external clients.
- Ability to bring closure to contracts on time and within designated parameters of profitability.
Conditions of Employment
- Must be employment eligible as verified by the U.S. Dept. of Health and Human Services Office of Inspector General (OIG) and the Government Services Administration (GSA).
- Must pass a pre-employment criminal background check.
- Fingerprinting, and subsequent clearance, is required.
- Must provide proof of varicella & MMR immunity or obtain vaccinations within 90 days of employment.
- Must obtain annual influenza vaccination.
- If this position is assigned to a clinical area, successful candidate will be required to complete a pre-placement medical evaluation/health screen. Required N-95 mask fitting, testing, vaccinations to include annual TST, Tdap, and Hepatitis B will be determined based on location and nature of position.
Working Conditions and Physical Effort
- Work is normally performed in a clinic or office environment.
- No or very limited exposure to physical risk.
- No or very limited physical effort required.