C2Q Health Solutions · 1 week ago
DIRECTOR, PROVIDER RELATIONS
Bronx, NY
Full-time
Onsite
Lead/Staff, Director/Executive
$138K/yr - $145K/yr
2+ years expC2Q Health Solutions is focused on developing and managing a robust provider network, and they are seeking a Director of Provider Relations to lead these efforts. This role involves overseeing provider contracts, ensuring compliance with regulations, and fostering strong relationships with various healthcare providers to optimize network performance.
Management Consulting
Responsibilities
Under the direction and guidance of the AVP of Network and Provider Contracting, lead and actively manage provider network development and contracting initiatives to support seamless onboarding, enrollment, and network growth
Directly oversee and participate in the end-to-end provider contracting and onboarding process, including rate configuration, system set-up, data loads, and quality assurance
Develop, negotiate, execute, and manage provider contracts (and Single Case Agreements) across a diverse network, including IPAs, primary care and specialty practices, LHCSAs, FQHCs, ancillary providers, hospital systems, and other provider organizations
Maintain oversight of the full contract lifecycle, ensuring accurate documentation, timely renewals, amendments, and execution within the contract management system. Work closely with Credentialing team to ensure timely and accurate credentialing deadlines and documentation for each provider to maintain the organization’s network adequacy
Serve as a subject matter expert for provider-related issues, conducting research and coordinating internal and external resources to resolve matters efficiently and with urgency. Perform direct outreach to providers for escalation of critical issues that need to be addressed timely
Address and resolve provider concerns promptly, delivering responsive, high-quality customer service related to contracts, operations, and reimbursement. Escalate any critical issues to the attention of the AVP and CFO
Work closely with Finance and Claims Operations in provider outreach and education related to claim appeals, over/under capitation and claims recoupment, and Nokomis and DRG Claims denial process
In collaboration with Marketing team, conduct LHCSA and SADC annual training, issue Quarterly Provider Newsletter, update Provider Manual and Provider Portal contents, and other provider related notifications
Provide support to Shared Services and Care Delivery teams in the collection of Nursing Home notes and provider escalation for other visit notes. Perform site visits to SADC sites new to the organization’s network
Develop staff in ensuring the adherence to administrative policies, procedures, that leads to process improvements to enhance operational efficiency, compliance, and innovation
Ensure provider network compliance with Medicare, Medicaid, PACE, OMIG, NYSOFA, HIPAA, and other federal and state regulatory requirements in collaboration with Credentialing, Compliance, and internal stakeholders
Respond to and close out Corrective Action Plans (CAPs) and internal or external audit inquiries, including those from CMS and NY DOH, ensuring timely and accurate submission of requested information across all legal entities
Monitor and manage provider communications, including timely response to provider relations inbox inquiries, portal access issues, and coordination with appropriate internal teams
Support compliance and operational initiatives such as LHCSA wage parity (LS300), provider training materials, and IRS 1099 name/TIN resolution
In coordination with Business Development team, represent the organization in external meetings, conferences, and community events as needed
Lead special projects and initiatives as assigned while upholding organizational policies, confidentiality standards, and productivity expectations
Assume accountability for assigned responsibilities, seek guidance when appropriate, and consistently meet performance and operational goals
Keep AVP of Network and Vendor contracting informed of progress, risk, and outcomes timely and close the loop on any follow-up discussions
All other duties assigned
Qualification
Required
Bachelor's Degree in Business, Healthcare Administration, or other related fields
Two to five (2-5) years of experience working in healthcare preferably in managed care contracting, provider relations, or network development
Familiarity with physician onboarding, ancillary providers, and VBP arrangements
Advanced computer skills including MS Office (Excel, Outlook, Word, etc.) and Adobe Acrobat
Highly organized, accountable, and detail-oriented
Customer service orientation with excellent follow-up and communication skills
Able to multitask efficiently and effectively as part of a team and independently
Solid critical thinking and problem-solving skills in a fast-paced, dynamic environment
Professional, friendly, and skilled in written communications
Standing – Duration of up to 6 hours a day
Sitting/Stationary positions – Sedentary position in duration of up to 6-8 hours a day for consecutive hours/periods
Lifting/Push/Pull – Up to 50 pounds of equipment, baggage, supplies, and other items used in the scope of the job using OSHA guidelines, etc
Bending/Squatting – Have to be able to safely bend or squat to perform the essential functions under the scope of the job
Stairs/Steps/Walking/Climbing – Must be able to safely maneuver stairs, climb up/down, and walk to access work areas
Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (ie. typing, use of supplies, equipment, etc.)
Sight/Visual Requirements – Must be able to visually read documentation, papers, orders, signs, etc., and type/write documentation, etc. with accuracy
Audio Hearing and Motor Skills (language) Requirements – Must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy
Cognitive Ability – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job
Preferred
Masters' candidates encouraged to apply
Company
C2Q Health Solutions
C2Q Health Solutions offers management services tailored to the needs and goals of healthcare providers.
201-500 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase