Director Of Provider Services
Job Title:
Director Of Provider Services
Type:
Full Time
Location:
Remote
About Us:
KeyCare offers health systems access to a network of virtual care providers working on KeyCare's Epic-based EMR and telehealth platform. This allows KeyCare to improve access for patients across the United States, while keeping their care coordinated with their health system partners. Health systems can start with nationwide virtual on-demand urgent care coverage (24x7, 50-state coverage), and then may add other virtual health services based on their needs. To learn more about KeyCare, visit www.keycare.org
Position Overview:
As the Director of Provider Services, this role will be responsible for working with the Chief Operating Officer, Chief Medical Officer, and vendor partners to support the growth of our virtual care services (telehealth). The Director will develop operational tactics and processes at the department level to support the company goals and strategies. This position directs and manages the day-to-day activity related to effectively staffing, managing, and maintaining the KeyCare Medical Group including but not limited to provider recruiting, credentialing, scheduling, training, payer enrollment, and provider relations. This role also assists with customer engagement activity relating to provider availability and utilization.
Key Responsibilities:
• Directs and supervises all unit personnel and activity related to provider recruiting, onboarding, credentialing, enrollment processes, provider file maintenance, communications, provider and payor enrollment, and delegated credentialing activity.
• Oversees, manages, and evaluates customer requirements as they may relate to credentialing and/or delegated credentialing activity; may negotiate contract terms as they relate to credentialing, delegation, and audits.
• Directs, manages, and oversees provider relations functions and activity within the organization in conjunction with Medical Group clinical leadership team, maintaining a broad knowledge and understanding of all aspects of provider relations and current provider issues, as well as issues related to day-to-day operations, such as claims payment and reimbursement, and other aspects including:
a. Organizing the provider Compensation Committee.
b. Provider administrative Performance Improvement Plans and off-boarding.
c. KCMG workforce management analytics and efficiency plans.
• Establishes and maintains essential relationships with payors and relevant departmental personnel within the health systems and other organizations essential to maintaining the provider network.
• Works directly with executives and legal counsel on matters relating to network participation, credentialing and network development, and related compliance issues.
• Manages all personnel functions within the unit and conducts necessary employee evaluations and reviews.
• Ensures important operational workflows are updated in compliance with federal, state, and safety regulations as necessary.
• Works closely with the management team to ensure anything affecting the performance of the operation is resolved effectively.
• Ensures that Provider Services maintains appropriate documentation including program descriptions, playbooks, policies, and other reference materials to maintain consistent operations.
• Ensures high provider satisfaction scores and collaborates with the Chief Medical Officer to develop and implement action plans to improve.
• Creates a positive and productive work environment to attract and retain talent.
In this role, you will:
• Collaborate with other directors and management teams.
• Proactively resolve operational issues including analysis preparation, escalation, financial impact assessment, recommended solutions and resolution.
• Participate in Payor Contracting and Alignment, and Division calls and meetings, including any needed preparation.
• Promote external and internal customer service-relationship building, including communication, active listening, training, education, and problem avoidance.
• Monitor trends and communicate significant shifts in market or operating conditions to leadership.
• Stay abreast of regulatory requirements and company compliance policies, ensuring timely staff education.
• Inform Provider Enrollment staff regarding payor requirements, significant changes, and developments.
Qualifications:
• Knowledge and understanding of standard credentialing guidelines and procedures related to credentialing and activity related to the maintenance of all provider credentialing and correspondence files
• Knowledge of general aspects of clinical care and clinic operations
• Experience in working with physicians, physician groups and hospital systems
• Knowledge and understanding of all aspects of provider relations
• Must possess above average oral and written communication skills and the ability to independently prioritize duties and assignments
• Must be capable of working under pressure situations and must be capable of adapting to various workloads and assignments
• Must be capable of working in an environment in which work is interrupted by staff, providers, and payors on priority matters
• Enthusiastic and creative leader with the ability to inspire others
• Demonstrated ability to work independently and with a sense of urgency in a dynamic environment
• 3 years managerial experience, including supervision of support staff and management oversight of individuals who are self-directed or organized
• Five (5) year’s progressive experience in provider credentialing and enrollment and provider relations, including but not limited to provider contracting, provider network administration, provider credentialing, and utilization management
• Experience with “Verifiable” credentialing software is a plus
Education, Experience, and Licensing Requirements
• Bachelor’s degree in Business, Healthcare Administration, or related area.
• Preferred experience in: Certified Provider Credentialing Specialist (CPCS), The National Committee for Quality Assurance (NCQA), Utilization Review Accreditation Commission (URAC), The Accreditation Association for Ambulatory Healthcare (AAAHC)
Travel Requirements
Travel required for key client events and staff retreats – up to 10%
Benefits:
Eligible for company benefits:
· Medical
· Vision
· Dental
· Life Insurance
· 401K
· Disability
· Unlimited PTO
How to Apply:
Please reach out to the email listed below.
Include the position title you are applying to in the subject line.
Include a brief intro in the body, and attach your cover letter and resume to the email. Our team will reach out with next steps.
How to Apply:
Please reach out via the external link button below.
You will be asked to attach a resume, and provide required personal info & provider details.
KeyCare is an Equal Opportunity/Affirmative Action Employer
We encourage all qualified applicants to apply. KeyCare is committed to its evolution towards a diverse and inclusive workplace. All qualified applicants will receive consideration for employment without regard to race, ethnicity, religion, gender or gender identity, sexual orientation, age, marital status, disability, sex, country of origin, or veteran status.
Reach Out to Our Team Today!
Our team is looking forward to hearing from you, and happy to answer any questions
