Provider Relations Account Manager – Network Growth

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

Benefits offered by this job

Referral bonus opportunities

Paid time off (PTO) 20 days + 9 paid U

Health insurance (medical, dental, vis

Employer-matched 401k

Tuition reimbursement

Professional growth & CEU credits

Job summary

VNS Health is seeking a Provider Relations professional to manage an assigned portfolio of provider relationships and act as the primary liaison with provider leadership and stakeholders.

The role supports provider agreements, education, and performance monitoring, coordinates complex issue resolutions, and collaborates across internal teams to ensure timely follow-up and compliance with Medicare/Medicaid requirements.

Qualifications

• 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
• 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

Responsibilities

• 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.

Skills

Relationship management

Provider engagement

Contracting

Education

Bachelor's degree or equivalent

Job description

VNS Health is seeking a Provider Relations professional to manage an assigned portfolio of provider relationships and act as the primary liaison with provider leadership and stakeholders.

The role supports provider agreements, education, and performance monitoring, coordinates complex issue resolutions, and collaborates across internal teams to ensure timely follow-up and compliance with Medicare/Medicaid requirements.