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Company Description:

KeyCare provides health systems with a network of virtual care providers who work on KeyCare's Epic-based EMR and telehealth platform. This enables health systems to enhance telehealth access for their patients in a coordinated manner, while reducing the workload on their own providers. Health systems can begin with nationwide virtual on-demand care (24x7, 50-state coverage), and expand to other primary care and specialty virtual health services as needed. Visit www.keycare.org for more information.

Position Description:

As the Director of Provider Services, this role will be responsible for working with the Chief Operating Officer, Chief Medical Officer, and vendor partners to support the growth of our virtual care services (telehealth). The Director will develop operational tactics and processes at the department level to support the company goals and strategies. This position directs and manages the day-to-day activity related to effectively staffing, managing, and maintaining the KeyCare Medical Group including but not limited to provider recruiting, credentialing, scheduling, training, payer enrollment, and provider relations. This role also assists with customer engagement activity relating to provider availability and utilization.

Responsibilities:

• Directs and supervises all unit personnel and activity related to provider recruiting, onboarding, credentialing, enrollment processes, provider file maintenance, communications, provider and payor enrollment, and delegated credentialing activity.
• Oversees, manages, and evaluates customer requirements as they may relate to credentialing and/or delegated credentialing activity; may negotiate contract terms as they relate to credentialing, delegation, and audits.
• Directs, manages, and oversees provider relations functions and activity within the organization in conjunction with Medical Group clinical leadership team, maintaining a broad knowledge and understanding of all aspects of provider relations and current provider issues, as well as issues related to day-to-day operations, such as claims payment and reimbursement, and other aspects including:

a. Organizing the provider Compensation Committee

b. Provider administrative Performance Improvement Plans and off-boarding

c. KCMG workforce management analytics and efficiency plans

• Establishes and maintains essential relationships with payors and relevant departmental personnel within the health systems and other organizations essential to maintaining the provider network.
• Works directly with executives and legal counsel on matters relating to network participation, credentialing and network development, and related compliance issues.
• Manages all personnel functions within the unit and conducts necessary employee evaluations and reviews
• Ensures important operational workflows are updated in compliance with federal, state, and safety regulations as necessary.
• Works closely with the management team to ensure anything affecting the performance of the operation is resolved effectively.
• Ensures that Provider Services maintains appropriate documentation including program descriptions, playbooks, policies, and other reference materials to maintain consistent operations.
• Ensures high provider satisfaction scores and collaborates with the Chief Medical Officer to develop and implement action plans to improve.
• Creates a positive and productive work environment to attract and retain talent.

In this role, you will:

• Collaborate with other directors and management teams.
• Proactively resolve operational issues including analysis preparation, escalation, financial impact assessment, recommended solutions and resolution.
• Participate in Payor Contracting and Alignment, and Division calls and meetings, including any needed preparation.
• Promote external and internal customer service-relationship building, including communication, active listening, training, education, and problem avoidance.
• Monitor trends and communicate significant shifts in market or operating conditions to leadership.
• Stay abreast of regulatory requirements and company compliance policies, ensuring timely staff education.
• Inform Provider Enrollment staff regarding payor requirements, significant changes, and developments.

Experience:

• 3 years managerial experience, including supervision of support staff and management oversight of individuals who are self-directed or organized.
• Five (5) year’s progressive experience in provider credentialing and enrollment and provider relations, including but not limited to provider contracting, provider network administration, provider credentialing, and utilization management.
• Experience with “Verifiable” credentialing software is a plus

Skills and Abilities:

• Knowledge and understanding of standard credentialing guidelines and procedures related to credentialing and activity related to the maintenance of all provider credentialing and correspondence files.
• Knowledge of general aspects of clinical care and clinic operations.
• Experience in working with physicians, physician groups and hospital systems.
• Knowledge and understanding of all aspects of provider relations.
• Must possess above average oral and written communication skills and the ability to independently prioritize duties and assignments.
• Must be capable of working under pressure situations and must be capable of adapting to various workloads and assignments.
• Must be capable of working in an environment in which work is interrupted by staff, providers, and payors on priority matters.
• Enthusiastic and creative leader with the ability to inspire others.
• Demonstrated ability to work independently and with a sense of urgency in a dynamic environment

Education, Certification, and/or Licensure:

• Bachelor’s degree in Business, Healthcare Administration, or related area
• Preferred experience in:

-Certified Provider Credentialing Specialist (CPCS)

-The National Committee for Quality Assurance (NCQA)

-Utilization Review Accreditation Commission (URAC)

-The Accreditation Association for Ambulatory Healthcare (AAAHC)

Benefits:

Eligible for company benefits:

• Medical
• Vision
• Dental
• Life Insurance
• 401K
• Disability
• Unlimited PTO

Travel Requirements:

Travel required for key client events and staff retreats – up to 10%

KeyCare is an Equal Opportunity/Affirmative Action Employer.

We encourage all qualified applicants to apply. KeyCare is committed to its evolution towards a diverse and inclusive workplace. All qualified applicants will receive consideration for employment without regard to race, ethnicity, religion, gender or gender identity, sexual orientation, age, marital status, disability, sex, country of origin, or veteran status.