FQHC Provider Network Account Manager

Network Account Manager

The Network Account Manager represents and advances Healthfirst interests in the Provider market as the preferred and ultimately preeminent plan through superior customer service and execution of Provider engagement strategies. The Network Account Manager represents commitment to developing and managing a high performance network and to engaging in various Provider engagement strategies that follow four core principles : Quality, Clinical Efficiency, Administrative Efficiency and Population Health.

Job Description

Serve as plan liaison for physicians / physician groups in a specified geographical area. Will be the main point of contact for all plan related issues including marketing, enrollment, contracting, billing and reimbursement.

Responsible for the resolution of all issues, including those identified by the provider, and those identified internally that have an impact on the physician. Coordinates with all Healthfirst staff to assist as appropriate, including creating project plans, issue logs, conference calls, etc.

Responsible for the provider recruitment process. Identify gaps, complete paperwork, etc.

Schedule frequent and regular face-to-face contact with the practice locations to identify any issues and ensure plan visibility.

Keep abreast of competitor activity, including new reimbursement and marketing strategies. Negotiate favorable rates with providers based on market trends.

Conduct new provider orientation and identify opportunities for education on both clinical and administrative topics. Includes experts in the field of education as needed from in-house staff.

Responsible for monitoring and reporting on providers' clinical quality & financial performance, working with their manager and other internal departments to create strategic improvement plans.

Working under light supervision, maneuvers multiple tasks independently with a fast paced proactive vs. reactive approach to changing priorities while meeting departmental objectives. Attention to managing many details and remaining focused in an environment with distractions.

Contribute creative solutions and ownership of daily assignments for seamless communication and systematic completion of routine and special projects. Follow protocols and use common sense to escalate situations to management appropriately.

Handle other duties as assigned with the occasional need to work weekends, overtime and / or travel throughout the tristate area. Engage in mastering the Division's impact on Healthfirst, its Members, and Providers

Minimum Qualifications :

High School Diploma or GED equivalent experience

Medicare and / or Medicaid managed care experience

Excellent oral and written communication skills (Letter writing, Memo, and Email)

Preferred Qualifications :

Bachelor's Degree from an accredited institution

Active driver license and access to a vehicle

Provider office operations experience

Ability to understand Provider claims reimbursement

Contract negotiation experience

Bilingual fluency (reading, writing, speaking) Chinese or Spanish and English

Exposure to multiple functions especially finance, business intelligence

Experience with Microsoft office such as Excel, Outlook, and / or electronic archiving

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and / or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.