Network Account Manager

HFMS HF Management Services, LLC; New York (NY); On-site; USD 69,000 - 100,000; Full time

Job summary

Healthfirst is seeking a Network Account Manager to represent the plan in the provider market and advance engagement strategies. The role involves serving as the main liaison for physicians and groups, coordinating recruitment, and negotiating favorable reimbursement terms.

You will collaborate with internal teams to resolve provider issues and ensure plan visibility across locations. The position requires a high school diploma, bilingual Spanish/English, and experience with Medicare/Medicaid

Qualifications

• Bilingual fluency in Spanish and English is required (reading, writing, speaking).
• Experience with Medicare/Medicaid managed care is preferred.
• Experience with provider office operations and claims reimbursement helps.

Responsibilities

• Represent Healthfirst in the Provider market as liaison for physicians/groups.
• Coordinate provider recruitment and engagement activities.
• Negotiate favorable/competitive provider rates based on market trends.
• Maintain timely communication and resolve provider issues across departments.

Skills

Bilingual Spanish/English

Provider relations

Contract negotiation

Medical claims knowledge

Professional writing

Communication skills

Education

High School Diploma or GED

Tools

MHS system

Macess

Electronic archiving

Job description

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. 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 elevate 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.

Minimum Requirements:

High School Diploma or GED from an accredited institution

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

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. If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [e-mail] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC. 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 with 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.

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.

About Healthfirst

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.