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Mgr, Provider Relations

The Company:  Aflac Dental & Vision
The Location: 

FL, US Remote, US

The Division:  Dental & Vision
Job Id:  1988

Job Summary

 

The Provider Relations Manager is responsible for executing the strategy for dental and vision provider recruiting.

 

Principal Duties & Responsibilities

 

• Train and educate the Provider Relations team to identify and generate new leads for provider recruitment to the Argus network, and to ensure all activities are being appropriately tracked in Argus systems

• Develop appropriate recruiting scripts and tools to assist the team in explaining the value in joining the Argus network

• Review and share PR team and individual performance using appropriate scorecards and pipelines, highlighting accomplishments and identifying performance improvement areas

• Set the weekly cadence of goals and needs for the PR team

• Acts as first level of escalation for all PR concerns from providers, engaging the Director, PR and Manager, Provider Operations as necessary

• Conduct new provider onboarding training to familiarize providers with Argus processes and communication channels

• Maintain and build strong business relationships with Providers and champion their requests to ensure a positive Provider experience and instill confidence in the Argus brand

• Ensure excellent inter-department communications for key coordination activities, such as grievance and appeals, referrals, single case agreements

• Ensure excellent, effective and timely communications with Argus Plan Clients

• Ensure that request, monthly/quarterly reports are delivered in a timely manner to Argus Plan Clients

• Assist the Manager, Network Operations, as requested with monthly reporting for health plan clients

• Negotiate/Re-negotiate contracts and fees with providers while being cognizant of utilization and cost

• Oversee on-boarding Provider Program, track compliance and export results as requested.

• Monitor the Provider Relations email inbox to ensure that the team is taking steps to quickly resolve all issues, and delegate as necessary.

• Be the primary trainer for the PR team in procedures and policies as directed by the VP of PR.

• Monitor PR team performance, timecard issues and adherence to company policies and report concerns to the Director, PR.

• Assist leadership as requested with department goal setting and communication of them the PR team.

• Track assigned duties and activities using the appropriate company resource (i.e. Acuity, logging into phone systems, etc.)

• Contribute to a positive working environment that motivates the team to be successful

• Meet and exceed performance goals consistently

• Comply with all Argus policy and procedures and accreditation standards

• Other duties and responsibilities as assigned by management

 

Leader - Education & Experience

 

Qualification Level Education Degree Specification

Preferred Bachelor's Degree Business Administration or related field

 

Qualification Level Experience

Minimum Required 5+ years of work experience in the dental and vision sectors Preferred Experience in HMO Provider/ancillary facility network management Preferred Familiarity with AAAHC, NCQA and CMS regulations

Minimum Required 2+ years leadership experience in the industry Or an equivalent combination of education and experience.

 

Job Knowledge & Skills

 

• Ability to navigate complex health plan enterprise systems

• Intellectual curiosity with a keen sense for data analysis and interpretation

• Efficient and concise communication skills

• Organized with excellent time-management capabilities

• Strong analytical and problem-solving skills

• Ability to work autonomously

• Detail-oriented

• Ability to multi-task effectively

• Microsoft Suite knowledge is a must

 

Organizational Competencies

 

· Acting with Integrity - Clearly states goals and beliefs; lets people know his/her true intentions; does what he she said they would do; follows through on commitments

· Communicating Effectively - Expresses ideas and information in a clear and concise manner; tailors message to fit the interests and needs of the audience; delivers information in a manner that is interesting and compelling to the listener

· Pursuing Self-Development - Demonstrates ambition and desire to move forward in his/her career; engages others in discussions about career development; seeks feedback on ways to increase his/her performance; takes advantage of opportunities to build new skills and capabilities

· Serving Customers - Builds strong relationships with customers; stays aware of customer needs, concerns and satisfaction; responds promptly to customer questions and requests; effectively manages customer expectations

· Supporting Change - Enthusiastically participates in new change initiatives and programs; focuses on reasons why changes will work and how they will be beneficial

· Supporting Organizational Goals - Actively supports organizational goals and values; demonstrates enthusiasm toward the company's goals and mission; aligns actions around organizational goals

· Working with Diverse Populations - Shows respect for the beliefs and traditions of others; encourages and promotes practices that support cultural diversity; discourages behaviors or practices that may be perceived as unfair, biased, or critical toward people with certain backgrounds

 

Leader Competencies

 

· Acting as a Champion for Change - Challenges the status quo; encourages people to question existing methods, practices, and assumptions; supports people in their efforts to try new things

· Demonstrating Initiative - Takes action on his/her own without being prompted; handles problems independently; able to resolve issues without relying on extensive help from others; does more than is expected or asked

· Developing Talent - Invests time and resources into building the capabilities of team members; helps people define career goals and establish development plans to achieve them; gives people constructive, developmental feedback and advice

· Managing Performance - Clearly defines and communicates roles and responsibilities; holds people accountable for accomplishing objectives; recognizes and rewards people who achieve results and deliver on performance expectations; provides effective feedback on performance

 

Working Conditions

 

The statements below describe the general nature and level of the work and are not an exhaustive list of all responsibilities, duties, and skills required.

Normal office environment (virtual or in-person)

 

Travel

 

None Required