Network Account Manager

US-NY-New York
Requisition ID
2017-15270

Overview

Healthfirst is a provider-sponsored health insurance company that serves more than 1.2 million members in downstate New York. With more than 4,000 employees, a network of nearly 30,000 providers, and revenues in excess of $8.6 billion, Healthfirst is one of the largest health plans in the New York City area.   Our members are our North Star, and our mission is guided by their needs and preferences in ensuring a superior experience and access to the highest quality healthcare when and where they need it. Healthfirst’s commitment to quality and member satisfaction has helped us earn top ratings for HMO health plans in New York City. We know that employees shape our company and connect us to our communities, and we look to recruit and retain intelligent, driven leaders who are passionate about healthcare and embody our five culture drivers: - Dream Big, Plan Wisely - Break Down the Walls - Think Critically, Speak Up, Deliver with Pride - Inspire Through Trust, Lead By Example - Be Unstoppable   Position Summary: The Network Account Manager represents and advances Healthfirst interests in the Provider market as the preferred and ultimately preeminent plan through superior customer service and execution of Provider engagement strategies.  The Network Account Manager represents commitment to developing and managing a high performance network and to engaging in various Provider engagement strategies that follow four core principles: Quality, Clinical Efficiency, Administrative Efficiency and Population Health.     Healthfirst is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity or expression, veterans, disability status  or any other characteristic protected by law.

Responsibilities

Duties and Responsibilities:

  • Serve as plan liaison for physicians/physician groups in a specified geographical area. Will be main point of contact for all plan-related issues including marketing, enrollment, contracting, billing and reimbursement. Responsibility for the resolution of all issues, including those identified by the provider, and those identified internally that have an impact on the physician. Coordinates with all Healthfirst staff to assist as appropriate, including creating project plans, issue logs, conference calls, etc.
  • Responsibility for the provider recruitment process. Identify gaps, complete paperwork, etc.
  • Schedule frequent and regular face-to-face contact with the practice locations to identify any issues and ensure plan visibility.
  • Keep abreast of competitor activity, including new reimbursement and marketing strategies. Negotiate favorable/competitive rates with providers based on market trends.
  • Conduct new provider orientation and identify on an ongoing basis opportunities for education on both clinical and administrative topics. Includes experts in the field of education as needed from in-house staff.
  • Responsible for monitoring and reporting on providers' clinical quality & financial performance, working with their manager and other internal departments to create strategic improvement plans.
  • Working under light supervision, maneuvers multiple tasks independently with a fast-paced proactive vs. reactive approach to changing priorities while meeting departmental objectives. Attention to managing many details and remaining focused in an environment with distractions.
  • Contribute creative solutions and ownership of daily assignments for seamless communication and systematic completion of routine and special projects. Follow protocols and use common sense to escalate situations to management appropriately.
  • Handle other duties as assigned with the occasional need to work weekends, overtime and/or travel throughout the tri-state area. Engage in mastering the Division's impact on Healthfirst, its Members and Providers.

Qualifications

Minimum Qualifications:

  • Experience related to network management, provider relations, sales, customer services, or healthcare
  • A valid driver's license and insured automobile
  • Experience with MS Word (create effective business correspondence), Excel (create formulas and functions), Outlook or similar corporate email and calendar system
  • Ability to work independently in a demanding fast-paced environment
  • Ability to prioritize and manage projects while multi-tasking
  • Strong problem-solving skills coupled with ability to facilitate resolution to issues
  • Follow strong Customer Service protocols while being mission driven, proactive and using critical thinking
  • An entrepreneurial spirit that looks to the best interests of the plan and its providers by bridging and creating common interests to develop meaningful provider partnerships and experiences for our members.
  • Excellent oral and written communication skills
  • High school diploma or GED

Preferred Qualifications:

  • Bachelor's degree
  • Bilingual fluency (reading, writing, speaking) Spanish and English
  • Medicare and/or Medicaid managed care experience
  • Experience with MHS, Macess, and/or electronic archiving
  • Provider office operations experience
  • Ability to understand Provider claims reimbursement
  • Contract negotiation experience
  • Professional Writing skills (Letter writing, Memo and Email)
  • Excellent oral and written communication skills

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