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Supervisor,Health Plan Provider Operations
- Job ID
- Business Development
This position is responsible for managing the day-to-day operations, configuration and maintenance of provider data, and for review, management and implementation of managed care health plan provider and paneling for the Enterprise. This position is responsible for the maintenance of provider data as well as paneling operations for the entire AltaMed network. The Supervisor will ensure providers are listed accurately in all health plans and across all applicable lines of business. This individual will monitor, assess, validate and implement standard paneling procedures to ensure health plan alignment to organizational goals. The position acts as a liaison between AltaMed and health plans to ensure changes are made to the Provider Network. The Supervisor will be responsible for providing oversight and leadership to the staff responsible for accurate and timely processing of provider paneling across all major systems used by AltaMed. Another core function of the position is to supervise the submission of contracts initiated by the Contracting department in order to ensure compliance and that business rules are constantly met. Focusing on program and process compliance; this position will ensure regular, periodic evidence-based reviews and audits of internal processes, and will assist with identifying potential risk areas. Partners with multiple internal customers to measure progress against goals, identify trends, implement process
- Lead the data collection for provider network, including the tracking of contracts as they are routed for credentialing.
- Provide oversight and supervision of Health Plan Provider Operations team, including performance management and coaching/development.
- Manages/Oversees the validation of health plan rosters to ensure network accuracy and overall increase Provider Listing Accuracy (PLA).
- Ensures that regular system audits take place to ensure that provider and health plan schedules/terms are accurately loaded.
- Manages effective, timely, and accurate submission of provider data to the health plans for paneling purposes to support membership growth.
- Supports and communicates effectively with leadership at the Corporate, Regional and Site levels as well as other key departments such as Compliance, Patient Access, and Contact Center.
- Works in collaboration with the Contracting and Patient Access to ensure compliance with health plan and all regulatory access requirements across the Enterprise.
- Prepares for and responds to internal and external audits, develops and implements corrective action plans for areas of responsibility. Reports any findings to the AVP of Managed Care Operations.
- Regularly monitors and reviews progress of direct reports to ensure that department goals and objectives are being met and staff is being held accountable for performance.
- Monitors, develops and implements policies and procedures.
- Makes recommendations for process improvement and productivity.
- Oversees hiring and training and of Health Plan Provider Operations staff in the areas of responsibility.
- Leads and participates in special projects; including but not limited to process development, compliance and training
- Perform all other related duties as assigned.
- Bachelor’s degree in Business Administration in related field or equivalent work experience. Master’s Degree preferred.
- Require minimum of 3 years of experience in managed care operations with at least 1 year of supervisory experience.