Manager Network Relations Database Management-SWHR CIN at Southwestern Health Resources CIN in Pittston, Pennsylvania

Job Description:

Southwestern Health Resources Clinically Integrated Network (SWHR CIN), is hiring for a Manager Network Relations Database Management.

The Manager, Network Relations Database Management works in conjunction with the Relations and Database Management Specialists to support the Director, Network Relations and Database Management. Scope includes oversight of Network Payor Relations, Network Data Management and Enrollment teams for Southwestern Health Resources. This position will report directly to the Director Network Relations and Database Management.

Location: Farmers Branch

Core Hours

• Full time, Monday through Friday, 8am-5pm

Job Description

Responsible for partnering with the Director, Network Relations & Database Management to oversee the provider/payor relations, database management, contract administration and enrollment projects that contribute to the strategic development of the SWHR Network.

Provides leadership and directs work for the Provider/Payor Relations, Contract Administration, and Provider Enrollment Staff including assigning work priorities and maintaining performance standards by counseling employees, performing performance appraisals, recruiting, recommends merit increases and provides required training.

Support SWHR CIN physicians with contracted MCOs when escalated from physician relations team.

Monitors and drives monthly/quarterly KPIs for Payor efficiency and effectiveness. Manages all auditing activity completion, findings corrections and oversees payor issues resolutions. Ensures staff data entry accuracy and database functionality.

In collaboration with the Director, leads monthly Joint Operations Committee Meetings with all Managed Care Organizations.

Manage provider databases that feed key systems for SWHR needs. Participate in direct production of standard reporting of adds, terms, changes to all payors (managed care, government, and ACO). Run adhoc reporting for SWHR teams and senior leadership as needed.

Monitors provider data management system(s) with capabilities that support network demographic data, enrollment, network directory, document storage, and fee schedule management. Suggests database enhancement initiatives for database(s) and system changes. Maintains standards for data integrity and identifies system issues integral to problem resolution.

Implements and communicates policies and procedures in payor relations and database management with a focus on process improvement to help eliminate redundancies. Responsible for implementing internal processes and procedures to meet and satisfy all regulatory and policy requirements including updates to Payor Resources and utilization of databases for staff.

Support SWHR Network directories for new product offerings or agreements and assists in launch.

Participate in regulatory and operating committees as needed including SWHR Phynd Master Provider Index Committee, UTSW Plan Code Committee, UTSW DEP/POS Committee, SWHR Payor Joint Operating Committee Chair, UTSW AEC Committee and UTSW Billing Managers Committee. Ensure regulatory compliance for contracted Managed Care Organization, ACO, CMS Medicare, Texas Medicaid and enrollment. Performs other duties as assigned.

Education
Bachelor's Degree in Business Administration, Health Care Administration, or other related field required

Experience
5 years progressively responsible experience working with private and/or government insurance billing and/or collection units. Must include 3 years of supervisor experience and 2 years in database management.

Skills
Experience seeing projects through the full life cycle
Proven ability to complete projects according to outlined scope, budget, and timeline
Strong familiarity with project management software tools, methodologies, and best practices
Proven ability to solve problems creatively
Strong interpersonal skills and extremely resourceful
Experience in Salesforce, Provider Data Management or Credentialing Databases
Ability to work in teams successfully
Managed Care Experience

Southwestern Health Resources (SWHR) is a patient-centered clinically integrated network of 29 hospital locations and more than 5,500 physicians and other clinicians. Formed by Texas Health and UT Southwestern, two of the region's leading healthcare systems, SWHR delivers nationally preeminent, highest-quality care in 16 counties across North Texas. SWHR is also the parent organization of Care N' Care Insurance Co., a regional Medicare Advantage Plan serving more than 13,500 members in the region.

The SWHR network includes physicians from UT Southwestern and Texas Health, and independent community primary care and specialty physicians. In partnership, our team implements physician-driven, value-based care strategies to coordinate care for more than 700,000 patients, resulting in lower costs and high-quality care. In 2020, the Centers for Medicare & Medicaid Services released the annual financial and quality results and, based on the report, SWHR is one of the nation's leading Next Generation Accountable Care Organizations, having saved nearly $120 million since joining the program in 2017.

At the heart of SWHR are people who help people. We care about those we serve and each other. To be the national leader in providing population-based healthcare, our more than 850 employees use their knowledge, data insights and clinical experience to deliver care to the right patient, at the right time and in the right setting. By connecting physicians to patients and clinical insights to better outcomes, SWHR lowers costs, optimizes value, and builds a better healthcare system for all.

We invite you to learn more about us at www.southwesternhealth.org .

Let's move healthcare forward - together.