JOB SUMMARY

The Provider Performance Supervisor is responsible for managing the team to improve key performance metrics, ensure effective communication, and monitor provider and IPA contract performance. This role involves regular visits and interventions to monitor compliance with quality, financial and operational indicators across different lines of business. The supervisor educates the team and providers on essential processes such as: billing guidelines, gaps closure, coding, and the use of Triple-S provider platform while supporting recruitment and maintaining a compliant provider network. Additionally, the supervisor plans, designs process, handles administrative supervision, and resolves conflicts by promoting open communication and solution-seeking. They lead the provider support strategy and manage the team working directly with network providers to initiate and maintain productive long-term relationships. This role requires in-depth knowledge of the work area and other key departments to align the organization's operational and strategic goals, managing activities independently and reinforcing these goals constantly.

ESSENTIAL FUNCTIONS

• Develop and Implement Provider Initiatives: Develops, manage, implements, and maintains effective provider support protocols, workflows, policies, and procedures to improve provider performance and satisfaction.
• Monitor and Control Department Progress Reports Monitors progress of initiatives and performance of PCPs and IPA projects and initiatives, provider outreach, site visits, ticket requests, and geographic access reports.
• Compliance and Reporting Ensures compliance with regulatory and accreditation requirements and reports work unit performance as required.
• Provider Education and Support Educates the staff and providers on billing, coding, quality key metrics, and use of the Triple-S provider platform, supporting recruitment and maintaining a high performance provider network.
• Conflict Resolution and Relationship Management Develops and maintains effective business relationships with providers, resolves contract-related issues, and promotes open communication and solution-seeking.
• Team Management and Development Manages and develops a team, including hiring, training, coaching, counseling, motivating, evaluating performance, and establishing disciplinary actions when necessary.
• Process and Workflow Management Plans, designs, and supervises processes, workflows, and work itineraries, ensuring efficient and effective operations.
• Special Projects and Initiatives Participates in and manages special projects and initiatives, ensuring tasks are completed on time and meet organizational goals.
• Provider Visits and Performance Monitoring Develop and monitor corrective action plans for providers in non-compliance with quality and performance indicators.
• Marketing and Communication Manages developing, maintaining, and distributing of marketing materials to assist providers and coordinates communication programs for providers to promote Triple-S products and programs.

EDUCATION

EXPERIENCE

Bachelor’s degree in business administration, Health Science or Natural Sciences, preferably; with one to three  years of experience.

LICENSES AND CERTIFICATIONS

COMPETENCIES