Department:Provider Network Management - Geisinger Health Plan
Work Type: Full Time
Hiring Manager: Keri Shively
This role is responsible for the day to day relationships with GHP partners and providers.
This role is responsible for provider recruitment, contracting and relationship management. This role will help manage the implementation of and all lifecycle activities of a partnership and/or relationship.
This role is responsible for responding to complex inquiries, solving non-routine problems using independent judgment and discretion, and ensuring partner and/or provider satisfaction. This role will provide support and will act as a technical resource regarding policies, procedures, workflows, complex partner/provider issues and training needs.
COMPETENCIES AND SKILLS:
Demonstrates a comprehensive understanding of complex financial arrangements and quality programs across health care products.
Demonstrates a strong knowledge of the healthcare market.
Demonstrates exceptional financial, analytical and problem solving skills, and understanding of legal documents.
Demonstrates excellent communications skills, written, verbal and presentation.
Ability to work independently and must be self-directed, must also be able to work in team environment to reach goals and objectives
Demonstrates substantive knowledge of managed care policy and direction.
EDUCATION AND/OR EXPERIENCE:
BA/BS Bachelor’s degree required.
Minimum 5 years of contract and network management experience required.
Knowledge of ICD, HCPCS, and CPT codes desired.
Requires possession of a valid driver's license.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Work is typically performed in an office environment. Must be willing to independently travel and be willing to accept occasional overnight travel requests. May require evening and weekend work hours.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
GEISINGER HEALTH PLAN (GHP) is the health insurance component of Geisinger and serves over 460,000 members in Pennsylvania and West Virginia. Begun in 1985, GHP provides high quality, affordable health-care benefits for businesses of all sizes, individuals and families, and Medicare beneficiaries.
About Geisinger: Geisinger is a physician-led health system comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan Geisinger is nationally recognized for innovative practices and quality care. Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family.
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter.
** Does not qualify for J-1 waiver.We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply.All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
*Domestic partner benefits not applicable at Geisinger Holy Spirit.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.