Provider Network Supervisor

JOB TITLE: Provider Network Supervisor

REPORTS TO: Medical Benefits & Claims Manager

DEPARTMENT: Medical Claims

POSITION TYPE: Salaried, Exempt

BARGAINING UNIT: Non-Bargaining Unit

SEIU Healthcare IL Benefit Funds is a dynamic benefits administration organization committed to providing the highest quality health and retirement benefits in the most financially responsible manner, while always acting in the best interest of the union members. The Fund serves over 20,000 union workers in the Nursing Home, Home Care, Child Care and Personal Assistant industries with the delivery of health and pension benefits. Our employees epitomize the Fund’s core values of quality service, interdependence, effectiveness, and accountability, and forge an alliance with one another to carry out our shared mission and common agreements for those we serve.

Position Summary:

The Provider Network Supervisor is responsible for overseeing and managing Provider Relations, Vendor Relations and contract management activity in the Claims Department. The Provider Relations Supervisor leads the provider relations and vendor relations staff by effectively applying technical competencies and leadership strategies to oversee employee supervision and ensure the team meets all policies, procedures, and performance goals of the Provider and Vendor Relations team. The work will focus primarily on effective supervision of staff, development and maintenance of strong relationships with medical providers, hospitals, and other vendor partners, efficient and accurate handling of provider and vendor inquiries, and process optimization. The Provider Network Supervisor will oversee the development and execution of health plan and network strategies, contract negotiations and contract agreements, and development of strong relationships with providers and vendors. The Provider Network Supervisor needs a high proficiency in working both collaboratively and independently to ensure providers, vendors, and members are being serviced timely and accurately.

The Provider Network Supervisor will maintain a high standard of performance while identifying problems, developing solutions and process improvements, and resolving issues with direct reports and other stakeholders. This position provides support and reports directly to the Claims Manager and will work collaboratively with other leadership.

Key Duties and Responsibilities:

The Provider Network Supervisor will be responsible for the following:

· Manages staff, demonstrating leadership qualities consistent with management values and mission.

· Effectively manage staff under a Collective Bargaining Agreement (CBA).

· Supervises staff in the management of addressing and resolving medical provider inquiries related to payment status and disputes, vendor and contracting issues.

· Reviews and approves staff time off requests and payroll processing.

· Develops and coaches staff through direct feedback, performance management, goal setting, and training and development, and effective employee relations.

· Cultivates an environment of high morale, empowerment, and continuous improvement, innovation, and initiative.

· Oversees immediate direct reports in key functional areas including compliance, medical plan network development, provider relations, vendor management, contracting, quality metrics, and interdepartmental processes and procedures.

· Meet weekly with staff to build relationships, review operational processes, issue directives, and provide performance progress.

· Prepare and conduct staff annual performance reviews.

· Works with the Claims Manager to establish key performance indicators (KPIs) to track growth and progress of goals and objectives; and tracks the quality of work performed by employees in pursuit of goals and objectives.

· Communicates professionally with leadership team, staff, members, medical providers, vendor partners, and other stakeholders as directed to develop effective working relationships.

· May be directed to professionally interface with government agencies, unions, members, attorneys, and consultants to develop effective working relationships.

· Establishes, assigns, distributes, and monitors quality and quantity of work while ensuring employees are held accountable for consistently meeting quality and production requirements.

· Assists with cultivating a team environment of high morale, empowerment, and continuous improvement, innovation and initiative.

· Ensures the compliance and regulatory guidelines are adhered to, including but not limited to PPACA, No Surprises Act, Transparency Rules, DOL, ERISA, HIPAA, and other required guidelines.

· Designs and implements policies and procedures to ensure team operations are in compliance with current federal requirements and as new regulations are issued.

· Oversees the maintenance of vendor and provider monitoring processes and contract tracking.

· Identifies issues and problems, develops solutions, and prepares recommendations, including the development of policies and procedures.

· Resolves medical provider call escalations and manages inquiries from plan participants, vendors, medical providers, billers, and consultants.

· Ensures effective operation of a benefits administration system that fully supports the functions of the department.

· Establishes relationships with medical review organizations, oversees medical cost management efforts, and ensures proper billing practices.

· Oversees the configuration of contract terms within the benefits administration system to ensure accurate payments are processed and reflected in the participant and provider explanation of benefits (EOBs).

· Maintains knowledge of all health plans and department operations.

· Performs other similarly related duties and special projects as required.

· Attend and participate in various meetings, including monthly All Staff meetings, department meetings, training sessions, task force or committee meetings, and other meetings as deemed appropriate to share, discuss, and solution for issues, as well as identify potential process improvements.

· Create one-on-one (1:1) agendas for all meetings using the Purpose, Outcome and Process (POP) Model and keeping thorough notes for each meeting.

Privacy and Security Responsibilities:

This position requires employee to handle Personal Identifiable Information (PII) and potentially Protected Health Information (PHI) for our members. You will be responsible and accountable for maintaining the confidentiality, integrity, and availability of all PII and PHI. You must report any suspected identity or HIPAA violation or breach to our HIPAA Privacy and Security Officer.

EDUCATION REQUIREMENTS:

· Bachelor’s degree in business management, healthcare administration, or other relevant fields.

· An equivalent combination of education, certification, training and/or work experience may be used to meet the minimum education qualifications.

JOB REQUIREMENTS:

• Minimum of seven (7) years related field experience, preferably in medical insurance, medical plan benefits or third-party administrator environment.

· Minimum of five (5) years analytical experience, healthcare pricing, provider relations and vendor management, and analysis of provider and vendor contracts.

· Minimum of three (3) years related supervisory experience, preferably in medical claims operations, medical plan benefits, or third-party administrator environment.

· Proven ability to lead, hold accountable and motivate a team to carry out the organizational mission and department objectives, understanding that attitude and behavior matter for a healthy and successful team.

· Excellent oral, written, and non-verbal communication and interpersonal skills with the ability to actively listen and share insight.

· Strong decision-making and organizational skills, with the ability to optimize the use of all available resources to deliver to multiple priorities.

· Experience specifically with healthcare and network contracts and claims analysis to report department statistics and make meaning of data to inform recommendations and decisions.

· Exceptional analytical and problem resolution skills with attention to detail and accuracy; ability to exercise independent and sound judgement.

· Analytical skills with emphasis on generation and utilization of data to drive operational and financial performance.

· Experience with quality control, process improvement, and data integrity.

· Working knowledge of medical benefit and claims system configuration.

· Knowledge and understanding the healthcare industry, including medical claims operations, ICD-10 Diagnosis Codes, CPT Procedure Codes, HCPC Codes, HCFA 1500,and UB-04 claim forms.

· Experience with desktop computers, laptop computers, printers, copiers, scanners, fax, and other office equipment.

· Proficient skills, intermediate to expert level, in Microsoft Office Suite (Word, Excel, Access, Power Point, Visio, and Outlook).

· Ability to organize, prioritize tasks, and meet deadlines.

· Ability to demonstrate teamwork and work independently.

· Exercise clear and concise judgement.

· Ability and willingness to assist in special projects and handle multiple tasks.

PREFERRED SKILLS:

· Prior multi-employer and Taft-Hartley trust fund experience strongly preferred.

· Master’s Degree in Business Management, Healthcare Administration, or other relevant fields.

· Prior work experience in network contracting, medical insurance and claims operations, health plan strategy and analytics; settings may include third party administrators, managed care, self-funded plans or hospital and medical provider system.

· Management of a hybrid workforce, with in-person and remote work expectations.

· Working knowledge of the basys/Bridgeway benefits administration system.

· Experience with project management software, such as Smartsheet.

· Experience with virtual conference software (Teams and Zoom).

· Internal and external awareness of social movements, labor movements, and political issues that impact healthcare and the organization.

Benefits:

SEIU Healthcare IL Benefit Funds offers a comprehensive health benefit (medical, dental and vision coverage) for employees and eligible dependents, including no employee premium option for employee only; competitive compensation; generous holidays and PTO policies; and a pension retirement plan.

Diversity creates a healthier atmosphere: SEIU Healthcare IL Benefit Funds is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

The SEIU Healthcare IL Benefit Funds vision is to create a more just and equitable society that fosters a lifetime of quality healthcare and financial security for all. We hope that our social justice values and the responsibility we take to operate a socially conscious organization aligns with your professional desire to contribute and serve with purpose.