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Health First · 17 hours ago

Senior Network Account Manager

New York, NY

Full-time

Onsite

Mid, Senior Level

$123K/yr - $188K/yr

Healthfirst is a healthcare organization dedicated to improving provider networks, and they are seeking a Senior Network Account Manager. The role involves developing and supervising a high-performance provider network, ensuring provider satisfaction, and promoting collaboration within the organization to enhance healthcare delivery.

Health CareHealth InsuranceHome Health CareHospitalMedical DeviceWellness

Responsibilities

Advance Healthfirst through superior customer service focused leadership in an assigned territory and team, which will help to optimize provider satisfaction

Educate and train network representatives in key business principles around profitability, network adequacy, quality, etc

Promote successful internal collaboration within Healthfirst for our providers:

Shared mutual goals by working directly with the hospital and affiliated provider teams to improve their clinical, quality and member satisfaction outcomes

Provide effective education and communication of Healthfirst benefits and policies, changes, and effects to individual practices

Collaborate, develop, and deliver appropriate reports that allow provider partners to better manage their patient population (roster, care plans, quality reports, etc.)

Propose and implement initiatives or process changes with providers that will ultimately encourage process improvements within the healthcare delivery/administrative structure

Provide customer service focused leadership to optimize provider satisfaction through timely and accurate issue resolution

Propose and implement initiatives or process changes with providers that will ultimately encourage process improvements within the healthcare delivery/administrative structure

Manage projects

Provides status of projects as well as ensures completion of projects assigned

Provides coaching/mentoring for staff

Identifies improvement for further training/education

Critical thinking that solves problems with a logical, analytical discipline with a view on how decisions may impact provider/practice operations

Understanding of various reimbursement methodologies as it relates to the community provider network

Strong grounding of core principles and the role of hospitals within both Clinical Efficiency, Population Health, and Administrative Efficiency

Proactively identify trends of issues, root causes and their magnitude, develop and implement action plans to closure

Ability to review and draw conclusions from reports that integrate job knowledge and practical applications that answer or respond to a question or issue or may lead to other issues

Fiscal understanding of reimbursement and utilization practices

Ability to analyze reports related to provider performance and relate provider practice patterns to overall trends

Negotiation skills which clearly allow for ranges of discussions with a clear line of escalation when necessary as well as presentation for approval from Senior Management

Regulatory/ Legal understanding of the contracting logistics

Solid understanding of terms of contracts and how they should be applied: financial, amendment, termination, etc

Understanding and ability to guide translation of contract terms into system rules, i.e., configuration, creation or amendment of new provider records and knowledgeable review to ensure accuracy of future claims

Ability to guide and facilitate the team’s contracting process from start to finish

Qualification

Medicare/Medicaid experienceContract negotiationProvider claims reimbursementProvider office operationsProject managementProfessional writingRegulatory understandingAnalytical skillsCritical thinkingNegotiation skills

Required

Medicare and/or Medicaid managed care experience

Provider office operations experience

Ability to understand provider claims reimbursement

Contract negotiation experience

Professional writing skills (Letter writing, Memo and Email)