Under the guidance of the Chief Operating Officer, the Provider Relations Manager is responsible for developing, implementing, and coordinating a successful partnership between our Medical Groups, network physicians and health plan partners to successfully deliver cost-effective medical care with outstanding improvement of the member’s health and overall satisfaction with Canopy Health.  The Provider Relations Manager will focus on several areas, including:  ensuring that providers and network partners understand Canopy Health’s policies, procedures, and processes; working with all parties to ensure that questions about claims are quickly addressed; working with Medical Group provider relations staff on areas of concern; reviewing all data relevant to Provider Disputes, working with staff within Canopy Health and our partner organizations on root-cause analysis of identified concerns, deploying new approaches to ensure provider satisfaction; and working closely with the Canopy Health staff (Patient Experience Leader, Contracting Manager, and Marketing Director) on areas of collaboration and focus.

PRINCIPAL ACCOUNTABILITIES

1.    Work closely with Canopy Health leaders to develop and deploy an effective Provider Relations program.  These leaders include:  Patient Experience Leader (focusing on members), Contracting Manager (focusing on provider contracts with facility providers and ancillary providers as well as education), Marketing Director (focusing on providing Canopy Health marketing materials and education to Medical Groups, facility providers, and ancillary providers), Medical Management (focusing on problem resolution and education), and our Managed Services Organization (focusing on claims and PDR remediation).  The ability to partner and collaborate is essential.

2.    Use data to identify areas where we have the opportunity to improve provider satisfaction. These areas include:  claims payment, provider disputes, education, and member problem resolution. The ability to interpret and analyze data, develop a story around what the data is telling us, and deploy a timely and effective approach are keys to success.

3.    Meet regularly with each of our Medical Group’s provider relations teams to understand concerns that we  need to address. Examples include working with the Canopy Health Marketing Director to develop new collateral materials and communication mechanisms to educate providers about Canopy Health and how to optimize workflows with our Medical Groups.

4.    Develop relationships with key partners from within our contracted facilities meeting with these partners regularly at their facilities, optimizing relationships and interactions between these facilities and Canopy Health and developing improvement plans for each facility when necessary.

5.    Maintain and update the Provider Manual and ensure that these updates are understood by all partners and are cascaded to front-line staff at partner organizations.

6.    Work closely with Canopy Health’s Managed Services Organization and Canopy Health team members to ensure that our credentialing obligations are complete and up to date across our network.  This activity includes tracking the facility credentialing process (I-3 database).  Work with Canopy Health’s Compliance team to identify and resolve credentialing deficiencies.

7.    Team with Contracting Manager on projects that can help improve and streamline the Provider experience.

8.    Other duties as required to ensure that Canopy Health’s operations are successful.  Maintain the privacy and security of PHI (Protected Health Information) as outlined in Canopy Health’s policies and procedures relating to HIPAA compliance.