Ancillary Services Network Account Manager

Healthfirst; New York (NY); Hybrid; USD 69,000 - 100,000; Full time

Job summary

Healthfirst is seeking an Ancillary Services Contractor to develop and maintain an extensive ancillary provider network in the New York area. You will focus on lowering claims costs, improving quality of care, and increasing provider satisfaction through contract negotiations and education.

Responsibilities include credentialing review, creating contracts, and resolving claims issues while coordinating with multiple departments to ensure accurate fee schedules and timely payments.

Qualifications

• Experience managing or performing high level servicing to a portfolio of customers/providers.
• Contracting experience with knowledge of reimbursement methodologies for ancillary services.
• Ability to work independently in a dynamic environment and manage multiple tasks.

Responsibilities

• Develop and maintain an Ancillary provider network to lower costs and improve care.
• Negotiate and execute provider contracts, including OON arrangements.
• Monitor contracted providers, load accurate demographics and fee schedules.
• Educate credentialed providers on policies, billing, and portal usage.
• Collaborate cross-departmentally to resolve claims issues and denials.

Skills

Provider recruitment

Contract negotiations

Credentialing

Claims resolution

Network development

Provider outreach

Data analysis

Communication skills

Relationship management

Education

High School Diploma

Job description

Job Overview

Under the direction of the Manager of Ancillary Services, the Ancillary Services Contractor develops and maintains an Ancillary provider network that ensures Healthfirst members have superior access to the highest quality by focusing efforts on lowering claims costs, improving the quality of care, and increasing member and provider network satisfaction.

The individual must possess experience working in a managed care setting with specific background in network development, provider recruitment, provider outreach, claim resolution, provider education and contract negotiations. Works with multiple provider types, e.g. physician, ancillary, medical groups, behavioral health or hospitals to support a full range of contract arrangements and pricing mechanisms.

Monitor and audit contracted ancillary providers to ensure that accurate demographic, payment and fee schedules are loaded into the HF Provider System correctly.

Manage a network of Ancillary Providers for all lines of Healthfirst's business (such as Medicaid, CHP, Medicare, and Commercial). Resolve configuration issues by identifying root causes in order to prevent claims denials and to ensure claims are paid correctly.

Facilitate meetings cross-departmentally to achieve positive outcomes in management of ancillary provider network.

Create contracts in HF contract software and review credentialing documents submitted by Provider/facility via Universal Credentialing Data Source, The Council for Affordable Quality Healthcare (CAQH) or PDF application to ensure that all the required credentials are included and that valid documents for behavioral Providers and facilities are provided.

Negotiate and execute Single Patient Agreements for Out Of Network (OON) Providers in order to determine the Provider's payment arrangement. Individual should be familiar with contracting and reimbursement methodologies for ancillary services providers.

Educate newly credentialed Providers on Healthfirst's policies and procedures such as billing and authorization requirements, utilization of Healthfirst's Provider portal, claims submission, etc., via various methods (telephonic, face-to-face, webinar, etc.).

Analyze provider network based on monthly report to ensure that Plan is meeting Health Plan Network (HPN) State requirements. The individual would work closely with Network Management, Credentialing, and the business analytics unit within the Ancillary department, to complete the analysis.

Identify root cause of claims issues and facilitate resolution by working closely with Reimbursement and Claims departments.

Clearly communicate resolutions and progress to the Providers.

Assist Appeals and Grievances (A&G) department by acting as liaison between Providers and A&G department to achieve favorable outcomes of member related issues, complaints, balance billing and other issues.

Ensure that all Providers’ inquiries received via email and phone call are addressed efficiently and effectively within required time-frame.

Assist management with research and facilitation of projects related to contract updates, new product implementation and new reimbursement methodologies. Additional duties as assigned.

Minimum Requirements

• Experience managing or performing high level servicing to a portfolio of customers/providers
• Contracting experience
• Ability to work independently in dynamic environment
• Ability to take initiative and work independently
• Ability to prioritize and multi-task
• Strong customer-centric and analytical skills
• Strong sense of urgency and self-motivational qualities
• Excellent oral and written communication skills
• High School Diploma or GED

Equal Opportunity Employer

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.

Hiring Range

Hiring Range*: Greater New York City Area (NY, NJ, CT residents): $68,900 - $99,620 All Other Locations (within approved locations): $61,300 - $91,120

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision. In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live. *The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role. Healthfirst is New York’s largest not-for-profit health insurer offering it’s nearly 1.7 million members access to high-quality, affordable healthcare. As part of the community for nearly 30 years, Healthfirst’s unique advantage is rooted in its belief that good health doesn’t start in a doctor’s office. The company’s mission is to put its members first by working closely with care providers and community leaders to address broader issues that can impact health and well-being. This value-based care model is the foundation of the company’s sustained growth in one of the most dynamic markets in the country. So, if you are passionate about what you do and want to work for a company that is focused on the future and dedicated to making a difference in people’s lives, then Healthfirst is for you.

Know Your Rights

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.