Senior Network Account Manager

Healthfirst • New York, New York • 1h ago

Advance Healthfirst through superior customer service focused leadership in an assigned territory and team, which will help to optimize provider satisfaction

Educate and train network representatives in key business principles around profitability, network adequacy, quality, etc.

Promote successful internal collaboration within Healthfirst for our providers:

*Shared mutual goals by working directly with the hospital and affiliated provider teams to improve their clinical, quality and member satisfaction outcomes

*Provide effective education and communication of Healthfirst benefits and policies, changes, and effects to individual practices

*Collaborate, develop, and deliver appropriate reports that allow provider partners to better manage their patient population (roster, care plans, quality reports, etc.)

*Propose and implement initiatives or process changes with providers that will ultimately encourage process improvements within the healthcare delivery/administrative structure

*Provide customer service focused leadership to optimize provider satisfaction through timely and accurate issue resolution

*Propose and implement initiatives or process changes with providers that will ultimately encourage process improvements within the healthcare delivery/administrative structure

Manage projects

*Provides status of projects as well as ensures completion of projects assigned

Provides coaching/mentoring for staff

Identifies improvement for further training/education

Critical thinking that solves problems with a logical, analytical discipline with a view on how decisions may impact provider/practice operations

Understanding of various reimbursement methodologies as it relates to the community provider network

Strong grounding of core principles and the role of hospitals within both Clinical Efficiency, Population Health, and Administrative Efficiency

Proactively identify trends of issues, root causes and their magnitude, develop and implement action plans to closure

Ability to review and draw conclusions from reports that integrate job knowledge and practical applications that answer or respond to a question or issue or may lead to other issues

Fiscal understanding of reimbursement and utilization practices

Ability to analyze reports related to provider performance and relate provider practice patterns to overall trends

Negotiation skills which clearly allow for ranges of discussions with a clear line of escalation when necessary as well as presentation for approval from Senior Management

Regulatory/ Legal understanding of the contracting logistics

Solid understanding of terms of contracts and how they should be applied: financial, amendment, termination, etc.

Understanding and ability to guide translation of contract terms into system rules, i.e., configuration, creation or amendment of new provider records and knowledgeable review to ensure accuracy of future claims

Ability to guide and facilitate the teams contracting process from start to finish

Minimum Qualifications:

Medicare and/or Medicaid managed care experience

Provider office operations experience

Ability to understand provider claims reimbursement

Contract negotiation experience

Professional writing skills (Letter writing, Memo and Email)

Preferred Qualifications:

Bachelors degree

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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