Account Manager, Provider Relations

What We Provide

• Referral bonus opportunities

• Generous paid time off (PTO), starting at20 daysof paid time offand 9 company holidays

• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability

• Employer-matched 401k retirement saving program

• Personal and financial wellness programs

• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care and commuter transit program

• Generous tuition reimbursement for qualifying degrees

• Opportunities for professional growth and career advancement and CEU credits

What You Will Do

• Manages all provider contracts in designated territory, including recruitment, credentialing, recredentialing and relationship maintenance through regular visits and ongoing contact with existing and potential providers.
• Prepares materials for and orient providers to contract terms and operating requirements, Health Plan program and eligibility requirements, and service coordination.
• Collaborates with the Network Development and Contracting and Service Operations departments to administer demographic changes and renewals to provider contracts.
• Monitors contract performance of network providers and serves as a liaison between the Health Plan and the Provider to ensure the flow of information regarding resolution of member service issues.
• Coordinates provider site visits, as needed.
• Coordinates and attends meetings to serve as a resource and addresses provider issues.
• Updates and maintains provider manuals with current Health Plan policies and procedures.
• Updates and proofs provider directories.
• Assists providers in triaging billing and claims disputes.
• Participates and collaborates with Compliance on Department of Health and internal audits.
• Participates in special projects and performs other duties as assigned.

Licenses and Certifications:

• Driver's license required

Education:

• Bachelor's Degree or equivalent related work experience, preferably in health care setting required

Work Experience:

• Must be local to the New York City metropolitan area
• Bilingual in Mandarin, Bengali or Urdu preferred
• Minimum three years health care experience required
• Knowledge of government programs, including Medicare and Medicaid preferred
• Prior experience in Provider Relations preferred