VP Provider Relations

Location: Birmingham, Alabama
Date Posted: 10-10-2017
About Seneca Resources:
Seneca Resources is client driven provider of strategic Information Technology consulting services and Workforce Solutions to government and industry.  Seneca Resources is a leading IT services provider with offices in Virginia, Alabama, Texas, and Florida that service clients throughout the United States.  The key to our success lies within our strong corporate culture which drives our business.  We challenge our staff through engaging work, and we reward our staff through competitive compensation, extensive professional training, and excellent opportunities for career advancement.  In turn, we look for only the best and brightest to join our team.
 
We are an Equal Opportunity Employer and value the benefits of diversity in our workplace.
 
Position Title: VP Provider Relations
Location: Birmingham, AL
Position Status: Full time
 
Summary: 
Under the direction of the CEO, this position is responsible for continued development of national PPO network, PPO rate negotiations, credentialing system, orientation of providers, and provider-related quality assurance. Oversees departmental staff and operations.
 
Specific Duties:
  • Under the direction of the CEO, and in cooperation with all divisions as deemed appropriate:
  • Oversee development, expansion, and maintenance of PPO network coverage, to include new provider identification, solicitation, and negotiation, as well as client/case-specific provider affiliations. 
  • Ensure adherence to established provider fee schedules. 
  • Recommend changes as appropriate. 
  • Supervise inpatient rate negotiations and approval of inpatient contracts.
  • Ensure accurate and complete process of initial and ongoing credentialing of PPO providers, in accordance with established policies and national accreditation standards. 
  • Maintain current and accurate provider files and PPO listing.
  • Administer BHS provider orientations, to include individual and regional provider training sessions. 
  • Arrange and provide for clinical training/continuing education for providers, as directed. 
  • Direct the production of a provider newsletter on a regular basis.
  • Ensure adequate QA monitoring of providers in compliance with policies, to include onsite inspection and ongoing performance and credentialing review.
  • Ensure the on-going development and maintenance of a computerized provider management system adequate for tracking utilization of resources, credentialing status and claims processing.
  • Provider Relations Division serves in direct support role to the Clinical Division. 
  • Assist Clinical Division as directed in client/case-specific provider hook-ups and problem-solving. 
  • Assist Clinical Division as directed in arranging for client EAP supervisor and employee training in-services.
  • Assist Clinical Division and Accounting/Marketing Divisions as requested in support services related to specific or potential client contracts.  
  • Assist in preparation of proposals as requested.
  • Maintain corporate, departmental and quality assurance policies and procedures. 
  • Recommend new policies/procedures as deemed appropriate. 
  • Recommend revisions to PPO contract forms as appropriate.
  • Participate in on-going marketing and provider relations efforts, as directed. 
  • Participate in special projects, on-going research and public relations efforts as appropriate. 
  • Maintain information on competition, provider rates by region or city, national statistics and relevant changes in the field. 
  • Make recommendations on product line enhancements. 
  • Prepare reports as requested.
  • Perform other related duties as directed or deemed appropriate. 
  • Attend meetings as requested. 
  • Advise CEO on developments in the field.
Qualifications:
  • Bachelors in related field.  Master’s degree preferable.
  • Five years provider relations experience required, preferably in PPO/HMO or similar setting
  • Experience in managed care/PPO environment.
  • Some experience/involvement in mental health field preferred.
  • Familiarity with case management/util. review functions.
  • Familiarity with computerized applications (PCs, Word, Access).
  • Experience in services to business, industry preferable
  • Experience with fiscal issues, rate negotiations, contractual terms.
  • Excellent communication skills (written and oral) and organization skills.
  • Experience in group presentations/speaking preferable.
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