Regional Provider Network Manager (Midwest region)

The range for this role is $70,000 - $95,000

Actual base pay will be determined based on a successful candidate's work location, skills/abilities, experience, and education. This role includes opportunity to receive an annual bonus target of 10% of annual eligible earnings. Actual bonus amounts are determined by length of time in role, individual performance, and organizational performance.

Candidates for this role will be covering the Midwest region and would need to have established residency in TN, IL, IN, MO or OH. Frequent travel to visit medical providers within the Midwest region will be required.

The Mission

At Christian Care Ministry we believe that Christians can, and should, share in one another’s burdens. Through the use of Medi-Share®, a healthcare sharing ministry for Christians, we cultivate that belief.

The Team

Everyone at Christian Care Ministry is in agreement with our Statement of Faith, which outlines our core beliefs. Although we aren’t perfect people, we are serving our perfect God to the best of our ability.

The Job

The Provider Network Manager is responsible for gathering and analyzing provider data and feedback, addressing any issues or concerns, and resolving them in a timely and efficient manner to ensure that provider satisfaction and access to the provider for our members remains in place. The Provider Network Manager will create long-term relationships with providers and engage with them regularly to ensure that they are appropriately informed and updated on Christian Care Ministry's products, service offerings, and the latest member-voted guideline updates.

Essential Job Duties & Responsibilities

Initiate and maintain effective channels of communication with service providers and clients

Gather, review, and verify relevant information relating to participating providers

Establish and maintain relationships with assigned providers through office visits, telephone calls, prompt resolution of issues, and excellent customer service

Conduct training for service providers on member-voted guidelines and new product offerings

Respond to questions from doctors' offices on any issues they are experiencing

Gather, review, and submit relevant documentation needed for bill processing

Maintain a working knowledge of all applicable federal, state, and local laws and regulations regarding healthcare

Assist call center staff with more complicated member eligibility queries received

Identify shortfalls in healthcare provision and initiate improvement opportunities

Facilitate direct contracts with critical providers and provider groups

Monitor, mitigate, and report member and provider abrasion related to cost containment vendors

Perform and/or administer research in ensuring effective, timely responsiveness to all provider issues through an established escalation process

Coordinate Provider Contract administration

Ensure updates and adherence to operational and administrative policies and procedures

Assist in developmental projects / policies / procedures and other related issues

Contribute to the exercise and expression of Christian Care Ministry’s Christian beliefs

All other duties as assigned

Essential Skills & Abilities

Advanced understanding of Christian Care Ministry Guidelines

Ability to effectively communicate and document all communication with internal and external customers in approved, auditable, and secure platforms and systems

Excellent oral and written communication skills

Interpersonal and intercultural competencies

Ability to read, interpret, and apply vendor and provider contracts

Ability to write routine reports and correspondence; and speak effectively with members, providers, and/or associates of the organization

Proficiency with Microsoft Office (Excel, Word, Outlook)

Core Competencies/Demonstrable Behaviors

Collaborates – builds partnerships and works collaboratively with others to meet objectives. This role requires a high level of internal customer interaction to meet objectives

Manages Conflict – handles conflict situations effectively

Interpersonal Savvy – relates openly and comfortably with a diverse group of people. Must be able to communicate effectively and build engagement across all audiences

Drives Results – consistently achieves results, even under tough circumstances and tight deadlines

Situational Adaptability – adapting approach and demeanor in real time to match the shifting demands of different situations

Courage – ability to have tough conversations and deliver accurate advice and decisions regardless of risk or potential criticism

Education and/or Experience

3-5 years’ experience with health plans, healthcare networks/PPOs, medical billing, provider relations, medical coding OR combination of education and experience required

Bachelor’s degree in a Healthcare or business related field is preferred

Proficiency in creating presentations, training documents, reports, and analytical graphs preferred

Agile, Lean, or other process improvement certification is preferred

Sales representative experience strongly preferred

Supervisory Responsibilities

This job has no supervisory responsibilities

Travel

Willing and able to travel up to 25% of the time to visit in person with medical providers

Incentives & Benefits

We work hard to serve our Medi-Share Members, but know we can only do that if we invest in our employees professionally, financially, physically, socially, and spiritually. We purposefully invest in our employees so that our employees can invest in others.

For full-time employees working 30 hours or more, some of our benefits include, but are not limited to:

Medical

Health Savings Account

Employer Paid Life Insurance and Long-term Disability Insurance

Dental

Vision

Short-term Disability

Accident, Critical Illness, Hospital Indemnity

401(k) – up to 4% match

Paid-time off – accrued bi-weekly

Wellness plan

Employee Assistance Program

Anniversary Awards Program

Birthday Awards