McLaren Health Care Dir Provider Relations IN in Indianapolis, Indiana
MDwise, Inc. Opportunity – Director Provider Relations
MDwise is your local, Indiana-based nonprofit health care company. We were founded in 1994 to help vulnerable populations needing health coverage in Indiana. Our parent organization, McLaren Health Care at https://www.mclaren.org/main/home.aspx , is a nonprofit integrated health system who believes all Indiana families should have access to high quality health care regardless of income. Our mission is to provide high quality health care. MDwise works with the State of Indiana and Centers for Medicare and Medicaid Services to bring you the Hoosier Healthwise and Healthy Indiana Plan health insurance programs.
MDwise is seeking the right individual to join our team in our Director Provider Relations department. As an employee of MDwise, you will be a part of a dynamic organization that considers all of our employees as leaders in driving the organization forward and delivering quality service to all our members.
The Director of Provider Relations is responsible for the overall direction and coordination of the Provider Relations department to include planning, directing, organizing, controlling, and evaluating the implementation of strategic plans that will ensure a functionally sound provider interaction and their continued viability to the organization. These responsibilities include but are not limited to: all activities related to the management and oversight of Provider Relations including Provider Contracting, Network Improvement, provider network expansion and Network Analysis. This position will be responsible for representing the Plan to all provider organizations.
Learn more about MDwise, Inc. at https://www.mdwise.org/ .
Bachelor’s Degree in business, health care or related field.
Five (5) years’ experience in a progressively more responsible leadership role leading Provider Relations, including contracting, network development, etc.
Three (3) years’ experience in a supervisor role leading a professional staff of five or more members in all phases of effective supervision.
2 years’ experience and knowledge of HMO, PPO, TPA, PHO and Managed Care functions (e.g. accounting/finance, reinsurance, EDI, marketing, administration, medical delivery, regulatory compliance, claims processing, membership/eligibility, contracting and risk arrangements and actuarial precepts).
In-depth understanding of claims administration as it pertains to provider payments, including CPT-4 codes, revenue codes, HCPCS codes, DRGs, etc.
Primary Location: Indiana-Indianapolis-MDwise Inc
Employee Status Regular
Req ID: 20006957