Hospital Relations, Health Plan Account Manager
Manhattan, New York Provider Relations
Apply Now Job ID R010681 Overview
Manages all aspects of provider relations within a specified geographic region. Regularly visits and maintains ongoing contact with existing / potential providers for relationship building, recruitment, credentialing, re-credentialing and assisting with provider issues and education.
Works under general supervision.
Compensation :
$30.71 - $38.41 Hourly
What We Provide
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
- Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
- Employer-matched retirement saving funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career advancement
- Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
What You Will Do
- Manages all provider contracts in designated territory, including recruitment, credentialing, recredentialing and relationship maintenance through regular visits and ongoing contact with existing and potential providers.
- Prepares materials for and orient providers to contract terms and operating requirements, Health Plan program and eligibility requirements, and service coordination.
- Collaborates with the Network Development and Contracting and Service Operations departments to administer demographic changes and renewals to provider contracts.
- Monitors contract performance of network providers and serves as a liaison between the Health Plan and the Provider to ensure the flow of information regarding resolution of member service issues.
- Coordinates provider site visits, as needed.
- Coordinates and attends meetings to serve as a resource and addresses provider issues.
- Updates and maintains provider manuals with current Health Plan policies and procedures.
- Updates and proofs provider directories.
- Assists providers in triaging billing and claims disputes.
- Participates and collaborates with Compliance on Department of Health and internal audits.
- Participates in special projects and performs other duties as assigned.
Qualifications
Licenses and Certifications :
Driver's license, required
Education :
Bachelor's Degree or equivalent work experience in a health care setting, required
Work Experience :
- Minimum three years health care experience, required
- Knowledge of government programs, including Medicare and Medicaid, preferred
- Prior experience in Provider Relations, preferred
- Reliable transportation to work sites, required
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