The Provider Relations Manager is responsible for the overall aspects of Appeals, Negotiations, Customer Service, and Correspondence Unit operations : Personnel Hiring, Quality Assurance of Product, Workflow, Maintaining the tracking of and accountability of staff regarding production standards and TO expectations.
Responsible for personnel addressing client and / or provider inquiries via email, fax, telephonic, or written correspondence ensuring adherence to contractual and state guidelines as well as client instructions.
This is a hybrid position.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES :
- Responsible for Appeals Unit, Negotiation Unit, Correspondence Unit and Customer Service
- Contact provider or appealing party to discuss findings at escalated levels
- Train, Assist and Direct Supervisors as needed
- Maintain reports and spreadsheets as needed
- Responsible for financial operations, including, but not limited to : productivity, profitability, expenses, budgeting, and billing
- Responsible for implementing new procedures / protocols as they can change frequently
- Responsible for directing a team of MedCheck employees in their day-to-day operations
- Responsible for quality of service provided
- Responsible for human resources matters
- Must be able to travel overnight and attend meetings
- Requires regular and consistent attendance
- Comply with all safety rules and regulations during work hours in conjunction with the Injury Illness Prevention Program (IIPP)
- Additional duties as assigned
KNOWLEDGE & SKILLS :
- Extensive knowledge of Workers Compensation fee schedules and regulations
- Excellent written and verbal communication skills
- Medical terminology and coding knowledge
EDUCATION & EXPERIENCE :
- 5+ years of medical claims processing and / or PPO negotiation experience in the Managed Care and Benefit Administration industries
- 2+ years of customer service experience working in the Managed Care and Benefit Administration industries
- Experienced in successful negotiation of Group Health, Workers Compensation, Auto and General Liability claims
- Experience handling benefit payment disputes and / or first level provider appeals
- Supervisor / Management experience required
PAY RANGE :
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors : federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions.
Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role.
The level may impact the salary range and these adjustments would be clarified during the offer process.
Pay Range : $67,086 $111,634
A list of our benefit offerings can be found on our CorVel website : CorVel Careers Opportunities in Risk Management
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.
ABOUT CORVEL :
CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries.
CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients.
We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w / Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
LI-Hybrid
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