Physician Business Manager (Provider Relations) - West Texas

This position functions as a subject matter expert in network operations. This position strives tobring consistency and experience to existing Physician Business Managers in the local market byanalyzing, reviewing, forecasting, trending, and presenting information for operational andbusiness planning. This position will organize and assist the local Physician Business Managersin achieving short and long term operational/strategic business goals/ by developing, enhancingand maintaining operational information and models. They also develop, in conjunction with thelocal Director/Manager, and implement effective/strategic business solutions through researchand analysis of data and business processes.

Primary Responsibilities:

• Analyzes risk pool and provider group performance to determine areas of focus or improvement opportunities.
• Develops strategies to align contracted provider groups with company initiatives, goals (revenue and expense) and quality outcomes.
• Create and develop action plans to achieve metrics in quality, coding and financial performance.
• Provides explanations and interpretations within area of expertise.
• Provides daily direction and guidance to existing local Physician Business Managers and acts as the subject matter expert for their assign area.
• Uses pertinent data and facts to identify and solve a range of problems through experience, research and collaboration.
• Assists local Physician Business Managers with investigating non-standard requests and problems.
• Prioritizes and organizes assigned workload of local Physician Business Managers is able to meet deadlines while delivering the best outcomes possible.
• Provides explanations, direction and information to others on topics within area of expertise.
• Collaborates with local Medical Director(s) to monitor utilization trends and profit pools to assist with developing strategic plans to improve performance.
• Solid analytical skills required to support, compile and report key information.
• Drive processes and technology improvement initiatives that directly impact Revenue, HEDIS/STAR measures and Quality Metrics, using standard project methodology (requirements, design, test, etc.).
• Use data to identify trends, patterns and opportunities for the business and clients. Develop business strategies in line with company strategic initiatives.
• Engage provider staff and providers in analysis and evaluation of functional models and process improvements; identify dependencies and priorities.
• Evaluate and drive processes, provider relationships and implementation plans.
• Produce, publish and distribute scheduled and ad-hoc client and operational reports relating to the development and performance of products.
• Collaborate with other Physician Business Manager- Area Leads to foster teamwork and build consistency throughout the market.
• Serves as a liaison to the health plan and all customers.
• Requires solid presentation skills, problem solving and ability to manage conflict and identify resolutions quickly.
• Have the ability to communicate well with physicians, staff and internal departments.

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

• Bachelors degree in Business or Healthcare Administration or related field required. (4 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelors degree).
• 5+ years experience in a related medical field or health plan setting, or managed care
• Knowledge of Managed Care and Medicare programs
• Ability to develop long-term positive working relationships
• Ability to communicate and facilitate strategic meetings with groups of all sizes.
• Strong business acumen, analytical, critical thinking and persuasion skills.
• Exceptional interpersonal skills with ability to interface effectively internally with all levels of staff and externally with a wide range of people including physicians, office staff, hospital executives, medical groups, IPAs, the press and community organizations.
• Strong verbal and written communication skills are required.
• Proficiency in Microsoft Word, Excel and PowerPoint.
• 50% Travel

Preferred Education

• Experience & Skills Risk Adjustment knowledge related to CMS reimbursement models

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