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INTRODUCTION

Manages a lower-complexity portfolio of contracted and prospective providers with general supervision. Serves as a primary provider contact for service, recruitment, contracting, implementation and issue resolution; leads straightforward negotiations using approved rates and standard terms; and supports provider performance and improvement initiatives. Responsibilities expand with demonstrated proficiency, with exceptions and higher-risk matters escalated to the manager.

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 assigned provider relationships and day-to-day service needs, prioritizing requests and maintaining ownership of issues and commitments through resolution.
• Recruits providers and lead straightforward contract negotiations, repapering and other assigned contracting activities using approved rates and standard terms. Coordinate implementation and escalate exceptions or matters beyond assigned authority.
• Investigates and resolves provider issues involving claims and billing, credentialing, provider data, authorizations, utilization management, quality, compliance, member service and contract implementation, partnering with internal teams as needed.
• Leads standard provider onboarding, orientation, education, system access and contract implementation; coordinate responsibilities, information and deadlines across providers and internal departments.
• Prepares for and lead provider operating discussions; communicate policies, performance expectations, corrective actions and available tools, and review account, claims, roster, attribution and service data to identify issues and improvement opportunities.
• Supports value-based payment arrangements and provider performance initiatives, including Stars, HEDIS, compliant risk adjustment, medical cost, quality, access and member experience, through education, data exchange, action planning and performance tracking.
• Coordinates assigned regulatory and compliance activities, including provider attestations, Model of Care training, delegated oversight, accreditation or audit requests and corrective-action follow-up.
• Leads defined initiatives or assigned portions of larger projects, maintaining plans, responsibilities, deadlines and decisions and escalating barriers when needed.
• Maintains complete and timely provider account, contracting, issue and outcome records in designated systems; report risks and complete assigned mitigation actions.
• Applies feedback and developing knowledge of managed care, reimbursement and provider performance to take on increasingly complex provider work.
• Exercises judgment with general supervision for lower-complexity provider work. Resolves day-to-day provider matters and agrees to operational resolutions, implementation plans, education and corrective actions within assigned authority.
• Leads straightforward negotiations using approved parameters and escalates nonstandard terms, significant risks and decisions outside delegated authority.
• Remains accountable for assigned provider relationships through contracting, implementation and ongoing service, including timely follow-through when work depends on other departments.
• Participates in special projects and performs other duties as assigned.

Qualifications

Education:

Bachelor's Degree in healthcare administration, business, public health, health services, communications, education, psychology or relevant work experience required

Work Experience:

• Ability to evaluate information, communicate clearly, organize work and follow through on commitments required
• Demonstrates sound judgment, readiness to learn managed care concepts and an understanding of when to seek guidance required
• Communicates clearly in writing, meetings and presentations. Uses facts and sound reasoning to explain recommendations and gain cooperation required
• Works effectively when information is incomplete or priorities change. Handles conflict and difficult conversations professionally required
• Adjusts work hours occasionally to accommodate provider meetings and business needs required
• Experience supporting Medicare, Medicaid, dual-eligible, managed long-term care or other government-sponsored healthcare programs, or experience in a provider practice or provider administration environment preferred

Pay Range

USD $66,300.00 - USD $72,000.00 /Yr.

About us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We’re one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.