Account Manager, Provider Relations (Health Plans)

VNS Health; New York (NY); On-site; USD 51,000 - 65,000; Full time

Benefits offered by this job

Referral bonuses

Generous PTO

Health, Dental, Vision

401k with employer match

Tuition reimbursement

Professional growth & CEU credits

Job summary

VNS Health in New York seeks a Provider Relations Manager to sustain and grow strategic provider relationships and network performance. You will coordinate contract education, marketing, and operational alignment with internal teams and external provider leadership.

The role emphasizes navigating government-sponsored programs, driving improvements, and maintaining timely follow-up while coordinating across departments to resolve complex issues.

Qualifications

• Strong relationship management skills and ability to engage with provider leadership.

Responsibilities

• Manage an assigned portfolio of provider relationships and serve as the primary point of contact for provider leadership.
• Support provider agreement implementation, education, and operational expectations with internal teams.
• Educate providers on plan policies, requirements, and regulatory programs.
• Monitor provider performance, identify trends and gaps, and coordinate resolutions with stakeholders.
• Lead or participate in provider meetings, reviews, and site visits to reinforce organizational priorities.

Skills

Relationship management

Education

Bachelor’s degree or equivalent

Job description

Overview

Manages and maintains relationships with an assigned portfolio of contracted and prospective providers, serving as a primary liaison between VNS Health Plans and provider organizations. Responsible for supporting provider engagement, operational performance, contract implementation, education, and resolution of provider-related issues. Works collaboratively with internal departments and provider leadership to address complex operational, contractual, claims, compliance, quality, and service-related matters. Monitors provider needs and performance, identifies trends and opportunities for improvement, and coordinates appropriate follow-up and resolution. The role requires general direction, strong relationship management skills, knowledge of managed care operations and government-sponsored programs, and the ability to effectively navigate and coordinate across multiple internal and external stakeholders.

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 20 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 401k retirement saving program
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care and commuter transit program
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement and CEU credits

What You Will Do

• Manages an assigned portfolio of provider relationships, serving as a primary point of contact for provider leadership and key stakeholders and maintaining ongoing engagement to support strong provider relationships and network performance.
• Supports the implementation and ongoing administration of provider agreements, including provider education, contract requirements, operational expectations, demographic updates, renewals, and coordination with Contracting and Network teams.
• Educates providers on VNS Health Plans policies, procedures, contractual requirements, government program requirements, eligibility, operational processes, and other health plan initiatives.
• Monitors provider performance, identifies trends, gaps, discrepancies, and opportunities for improvement, and collaborates with internal and external stakeholders to develop and implement appropriate resolutions.
• Coordinates resolution of complex provider issues involving claims, billing, configuration, credentialing, contracting, quality, compliance, utilization, member service, and other operational matters, while maintaining ownership of the provider relationship through resolution.
• Serves as a liaison between providers and internal departments, facilitating communication and coordinating cross-functional efforts to address provider concerns and ensure timely follow-up.
• Leads and/or participates in provider meetings, business reviews, education sessions, site visits, and other provider engagement activities; prepares relevant materials and communicates organizational priorities and expectations.
• Coordinates provider-related initiatives and special projects, including implementation of new programs, regulatory requirements, operational changes, and other health plan initiatives impacting the provider network.
• Reviews provider data, reports, and other available information to identify discrepancies, trends, and potential areas of risk and escalating issues to the appropriate internal stakeholders.
• Partners with Compliance and other internal departments support Department of Health, regulatory, contractual, and internal audits and assist with provider follow-up and corrective actions as appropriate.
• Maintains accurate and timely documentation of provider interactions, activities, issues, and follow-up within designated systems and tools.
• Provides feedback to internal stakeholders regarding provider concerns, operational barriers, recurring issues, and opportunities to improve provider processes and the overall provider experience.
• Maintains current knowledge of VNS Health Plans products, provider network operations, applicable Medicare and Medicaid requirements, regulatory expectations, and organizational policies and procedures.

Qualifications

Licenses and Certifications: Drivers license required

Education: Bachelor's Degree or equivalent related work experience and relevant professional experience, preferably in healthcare, business, public health, health services, or a related field required

Work Experience: Minimum three years of experience in provider relations, account management, managed care, healthcare operations, network management, contracting, or a related healthcare field required

Working knowledge of government-sponsored healthcare programs, including Medicare and Medicaid, and their impact on provider operations, reimbursement, eligibility, and regulatory requirements preferred

Prior experience in Provider Relations, Provider Network Management, Account Management, Contracting, or a related healthcare function preferred

Pay Range

USD $37.32 - USD $46.66 /Hr.

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.