Ancillary Network Account Manager

Healthfirst; New York (NY); On-site; USD 68,800 - 99,620; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Life insurance

401k contributions

Incentive and recognition programs

Job summary

Healthfirst is seeking an Ancillary Services Contractor to develop and maintain a provider network, ensuring members have high-quality services. The successful candidate will manage networks for various lines, monitor provider data, and educate providers on policies.

Quality candidates will possess experience in contracting, strong customer service, and excellent communication skills. The position offers competitive salaries and comprehensive benefits, ensuring a supportive work environment.

Qualifications

• Experience managing or performing high-level servicing to a portfolio of customers/providers.
• Ability to work independently in a dynamic environment.
• Strong sense of urgency and self-motivational qualities.

Responsibilities

• Manage a network of ancillary providers across various lines of business.
• Monitor and audit contracted providers for accuracy in data.
• Negotiate and execute agreements with out-of-network providers.

Skills

High level servicing to customers/providers

Contracting

Initiative

Prioritization and multitasking

Customer-centric skills

Analytical skills

Communication skills

Education

High School Diploma or GED

Job description

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 supports a full range of contract arrangements and pricing mechanisms.

Responsibilities

• Manage a network of Ancillary Providers for all lines of Healthfirst's business (such as Medicaid, CHP, Medicare, and Commercial).
• Monitor and audit contracted ancillary providers to ensure that accurate demographic, payment and fee schedules are loaded into the HF Provider System correctly.
• 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 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

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.