Account Manager, Provider Relations

Overview
Manages all aspects of provider relations within a specified geographic region. Regularly visits and maintains ongoing contact with existing/potential providers for relationship building, recruitment, credentialing, re-credentialing and assisting with provider issues and education. Works under general supervision.

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.

Qualifications
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