Senior Provider Network Representative

Amida Care, Inc.; New York (NY); On-site; USD 66,000 - 83,000; Full time

Job summary

Amida Care seeks a Senior Provider Network Representative to develop and maintain relationships with physician groups and hospitals across New York. You will manage contracts, credentialing, and policy compliance while coordinating provider data and service quality.

The role requires healthcare administration experience, strong negotiation and communication skills, and the ability to travel within the NYC area.

Qualifications

• Minimum five years in health care; at least three years in provider/payor contracting.
• Experience developing contract terms and fee arrangements.
• Proficient with Word, Excel, Access.

Responsibilities

• Develop and maintain relationships with providers and physician groups.
• Handle credentialing, contracts, and regulatory compliance.
• Lead provider service visits and address inquiries.
• Coordinate contract management strategies and data quality.
• Monitor IPRO/Access compliance and performance metrics.

Skills

Healthcare knowledge

Contracting experience

Relationship management

Travel flexibility

Organizational skills

Cultural sensitivity

Education

Bachelor's degree in healthcare administration

Tools

Microsoft Office

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Senior Provider Network Representative

OPS- Provider Services Salary FT Exempt Non Senior Staff Full-Time Professional New York, NY, US

2 days ago Requisition ID: 1597

Salary Range: $66,033.00 To $82,547.00 Annually

Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member.

We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit Amida Care for more information about the Amida Care culture.

We are actively seeking a highly motivated, innovative and experienced individual to join our team as the Senior Provider Network Representative. Compensation will be commensurate with experience.

Position Summary

This position develops, contracts, maintains, and enhances relationships with facilities and physicians to drive business results. This position is responsible for the appropriate representation of providers relating to contractual arrangements, compliance, regulatory, credentialing, claims, provider files and administrative policy and procedures. This position may be assigned to service sponsors and/or other large provider entities, possibly in multiple boroughs.

Responsibilities:

• Develop and retain effective relationships with physician and business leadership of key physician groups and delivery systems within designated geographic area(s) to drive business results.
• Mentor team members and manage escalations effectively. Responsible for more complex and high priority contracted health systems.
• Conduct regular service visits to ensure provider service needs are met, resolve issues, educate providers and provider staff on policies and the web-portal usage, collect credentialing information, and review Healthcare Effectiveness Data and Information Set (HEDIS) information, etc.
• Respond to incoming provider inquiries from assigned providers and resolve issues. Assist colleagues with complex provider inquiries.
• Implement and/or provide ongoing relationship management for large, high profile physician groups, Independent Practice Associations (IPAs), and hospital systems with positive business results.
• Coordinate exchange, data updates, and follow-up of credentialing delegation rosters, provider file related functions, and provider rates implementation initiatives.
• Manage the delegated provider roster process by ensuring accuracy and timelines for data processing.
• Contracting with community and hospital-based physicians and ancillary providers.
• Perform duties related to regulatory compliance and applicable organizational requirements.
• Facilitate and manage Single Case Agreements as required.
• Conduct monthly calls to provider network to ensure compliance with IPRO/ Access and Availability.
• Identify potential claims trends, identify systems trends, and correct root causes for organization's provider systems data issues.
• Monitor contracts to ensure contract administration objectives are achieved and oversee provider data quality assurance.
• Chair regular contract relations meetings with key groups.
• Coordinating contract management strategies with hospital and ancillary lead to ensure appropriate coordination of organization's network strategy.
• Assist with the development and execution of strategies for member growth and achievement of medical cost targets.
• Perform other duties as assigned.

Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.EDUCATION REQUIRED

• Bachelor’s degree in health care administration, business or an equivalent combination of education and work experience in managed care or health care.

EXPERIENCES AND/OR SKILLS REQUIRED

• Minimum of five (5) years' experience in health care; including a minimum of three (3) years in provider/payor contracting.
• Extensive experience in developing contract types, fee arrangements and other contract terms and in developing and recommending potential solutions to contract issues.
• Proficiency in Microsoft Office software (Word, Access, Excel).
• Ability to travel efficiently and continuously to and within assigned geographic area.
• Strong organizational and project management skills.
• Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
• Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values.