Senior Provider Network Representative

2 weeks ago

New York, United States Amida Care Full time

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 Amidacareny.org for more information about the Amida Care culture.

We are actively seeking a highly motivated, innovative, and experienced leader 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 key high volume 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:

  • Develops 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.
  • Act as resource for others with less experience.
  • 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.
  • Provide delegated provider with quarterly roster participating providers and oversee audits for accuracy.
  • Manage delegated roster submission and assure timely receipt and loading into provider database.
  • Contract with community and hospital based physicians and ancillary providers.

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 years' experience in health care; including a minimum of three 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.

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