Job Description

Description:

General Position Summary:

This position is responsible for the overall success of BPA Health's provider network, including provider recruitment, contracting and credentialing, quality assurance and improvement, data management and reporting, and compliance and risk management. The successful candidate is outgoing, thoughtful, creative, and takes initiative. They understand how provider network management excellence is critical to the company's overall success and are excited to achieve and maintain the highest quality standards. The Provider Services Manager is responsible for leading and managing the Provider Services team to sustain performance excellence and desired provider network management results, carefully considering potential impacts on internal and external stakeholders.


In all aspects of the position, the Provider Services Manager leads and consistently operates in alignment with the company values: Actively Engage, Growth Mindset, Do the Right Thing, & Do What You Say.

Key Outcomes

Leading, managing and holding people accountable Network adequacy Provider recruitment & retention Provider satisfaction & success Provider education & training Provider quality Contract management & reporting

Essential Responsibilities

Leads and manages Provider Services team, including hiring, training, and coaching for maximum performance Works cross-functionally to execute network strategies in alignment with sales goals Collaborates with Senior Leadership and Medical Director to ensure provider network management process aligns with company objectives and standards Ensures proactive, effective, and consistent communication with providers Manages the workflow effectiveness and efficiency, budget, all daily activities, and issues within the department Ensures network adequacy and cost effectiveness Manages all aspects of preparation for and actions out of Credentialing Committee Assesses the types of providers needed based on service offerings and employee demographics Actively seeks qualified providers Gathers data on provider performance, patient outcomes, and service utilization for analysis. Generates reports to share insights with stakeholders and inform decision-making Drafts, recommends, and writes both standard and specialized contracts, ensuring that all required components are included Develops and maintains contract templates, includes collaborating with executive leadership and legal counsel, as appropriate Ensures contracted providers maintain compliance with contract terms and requirements Understands and manages required regulatory compliance for provider network including compliance with HIPAA, CFR42, IDAPA, and all other applicable state and federal laws Plans, implements and delivers provider education and training Establishes channels for providers and employees to provide feedback on services and network effectiveness Ensures effective provider relations by maintaining necessary relationships with behavioral health professional organizations and cultivating relationships with key current and potential providers

Secondary Functions:

Develops and maintains department process improvements Required to read and follow all company policies and procedures Other duties and responsibilities as assigned

Supervisory Responsibility:

Manages Provider Network Management team


Requirements:

Specific Job Skills & Competencies:

Excellent time management, evaluation of daily workflow and prioritization Strong relationship management expertise Excellent interpersonal, verbal and written communication Strong public speaker Organizational acumen Skilled in leading high-performing teams focusing on team morale and cohesiveness Strategic thinking and planning; the ability to create structure from ambiguity Detail-oriented and accurate with the ability to manage multiple projects at one time Excellent negotiation skills Strong analytical skills to refine provider network and to assure appropriate network Successful data gathering, statistical analysis and report creation skills Adherence to the values and mission of BPA Health

Required Education and/or Equivalent Experience:

Bachelor's degree in Health Administration, Business Administration or related field plus 5 years related experience; or the equivalent combination of work experience and education 2 years minimum experience in provider network management Progressive experience with demonstrated capabilities supervising, coaching and developing team Knowledge of the managed care industry regulatory and legal requirements, products, programs, strategy and objectives 3-5 years working with healthcare providers, clients and other stakeholders preferred Presentation and training experience preferred Analytical skills and statistical background preferred Proficient with MS Office, including Word, Excel, PowerPoint and Outlook

Travel Requirements

Approximately 20% of time out of the office with customers, providers and other stakeholders. Ability to make trips involving overnight stays. Means of transportation required.

Physical Requirements:

While performing the duties of this job, the employee is continuously required to read, talk and hear. The employee is continuously required to walk, sit or stand at a computer workstation, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.