Assistant Manager - Provider Network Management

Responsibilities

·        Develop and oversee provider education, recruitment, and intervention efforts for 1199SEIU Funds

·        Oversee Provider Relations Representatives (Field and In-House) assigned to territories in the Funds Network; conduct site visit verification to ensure Provider Relation Representatives are meeting site visits goals and expectations 

·        Handle escalated issues (i.e. recruitment requests, enhanced fee negotiations requests, provider complaints, appeals, claim files)

·        Manage the Home Care Fund plan including roster distribution; ensure providers are knowledgeable of Funds programs and policies

·        Assist with implementation of cost containment programs

·        Generate reports including Executive reports to track staff performance; meet with staff regularly; coach and mentor staff to ensure network management goals and initiatives are met

·        Assess training needs and develop plans to ensure staff are trained on policies and procedures, and new programs

·        Perform additional duties and projects as assigned by management

 

Qualifications

·        Bachelor’s Degree in a related field; or the equivalent years of experience required 

·        Minimum four (4) years experience with provider recruitment, contracting and credentialing, to include a minimum of two (2) years supervisory experience required

·        Experience in a healthcare plan or managed care setting

·        Knowledge of healthcare management systems, healthcare terminology, medical billing, reimbursement payment structures and Medicare terminology

·        Proficiency in Microsoft Office; able to navigate web-based systems  

·        Excellent interpersonal and communication skills – oral, written and listening

·        Strong organizational skills with ability to work in a fast-paced environment and juggle multiple competing tasks and demands

·        Excellent customer service skills; able to build and maintain relationships, and diffuse difficult situations

·        Demonstrated leadership skills with ability to interact and communicate with individuals at all levels of the organization in a professional manner.

·        Must have high ethical standards to handle sensitive and confidential situations. Position continually requires demonstrated integrity, honesty, poise, tact, and diplomacy.

·        Must be able to travel throughout New York and New Jersey