New!
Account Manager UMI / Opustone
Jamesburg, NJ3 days ago
Highlights
Minimum three years of experience in provider relations, account management, managed care, healthcare operations, network management, contracting, or a related healthcare field requiredWorking knowledge of government-sponsored healthcare programs, including Medicare and Medicaid, and their impact on provider operations, reimbursement, eligibility, and regulatory requirements preferredPrior experience in Provider Relations, Provider Network Management, Account Management, Contracting, or a related healthcare function preferred. The role requires general direction, strong relationship management skills, knowledge of managed care operations and government-sponsored programs, and the ability to effectively navigate and coordinate across multiple internal and external stakeholders.
Numbers & Facts
| Location | New York, New York |
| Job Type | Full-time |
| Salary | $37.32–$46.66 Per Hour |
Description
Overview:
Manages and maintains relationships with an assigned portfolio of contracted and prospective providers, serving as a primary liaison between VNS Health Plans and provider organizations. Responsible for supporting provider engagement, operational performance, contract implementation, education, and resolution of provider-related issues. Works collaboratively with internal departments and provider leadership to address complex operational, contractual, claims, compliance, quality, and service-related matters. Monitors provider needs and performance, identifies trends and opportunities for improvement, and coordinates appropriate follow-up and resolution. The role requires general direction, strong relationship management skills, knowledge of managed care operations and government-sponsored programs, and the ability to effectively navigate and coordinate across multiple internal and external stakeholders.
Responsibilities:
Qualifications:
Licenses and Certifications:
Drivers license required
Education:
Bachelor's Degree or equivalent related work experience and relevant professional experience, preferably in healthcare, business, public health, health services, or a related field required
Work Experience:
Minimum three years of experience in provider relations, account management, managed care, healthcare operations, network management, contracting, or a related healthcare field requiredWorking knowledge of government-sponsored healthcare programs, including Medicare and Medicaid, and their impact on provider operations, reimbursement, eligibility, and regulatory requirements preferredPrior experience in Provider Relations, Provider Network Management, Account Management, Contracting, or a related healthcare function preferred
Pay Range: USD $37.32 - USD $46.66 /Hr.
What We Provide
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 20 days of paid time off and 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 an assigned portfolio of provider relationships, serving as a primary point of contact for provider leadership and key stakeholders and maintaining ongoing engagement to support strong provider relationships and network performance.
- Supports the implementation and ongoing administration of provider agreements, including provider education, contract requirements, operational expectations, demographic updates, renewals, and coordination with Contracting and Network teams.
- Educates providers on VNS Health Plans policies, procedures, contractual requirements, government program requirements, eligibility, operational processes, and other health plan initiatives.
- Monitors provider performance, identifies trends, gaps, discrepancies, and opportunities for improvement, and collaborates with internal and external stakeholders to develop and implement appropriate resolutions.
- Coordinates resolution of complex provider issues involving claims, billing, configuration, credentialing, contracting, quality, compliance, utilization, member service, and other operational matters, while maintaining ownership of the provider relationship through resolution.
- Serves as a liaison between providers and internal departments, facilitating communication and coordinating cross-functional efforts to address provider concerns and ensure timely follow-up.
- Leads and/or participates in provider meetings, business reviews, education sessions, site visits, and other provider engagement activities; prepares relevant materials and communicates organizational priorities and expectations.
- Coordinates provider-related initiatives and special projects, including implementation of new programs, regulatory requirements, operational changes, and other health plan initiatives impacting the provider network.
- Reviews provider data, reports, and other available information to identify discrepancies, trends, and potential areas of risk and escalating issues to the appropriate internal stakeholders.
- Partners with Compliance and other internal departments support Department of Health, regulatory, contractual, and internal audits and assist with provider follow-up and corrective actions as appropriate.
- Maintains accurate and timely documentation of provider interactions, activities, issues, and follow-up within designated systems and tools.
- Provides feedback to internal stakeholders regarding provider concerns, operational barriers, recurring issues, and opportunities to improve provider processes and the overall provider experience.
- Maintains current knowledge of VNS Health Plans products, provider network operations, applicable Medicare and Medicaid requirements, regulatory expectations, and organizational policies and procedures.
Drivers license required
Education:
Bachelor's Degree or equivalent related work experience and relevant professional experience, preferably in healthcare, business, public health, health services, or a related field required
Work Experience:
Minimum three years of experience in provider relations, account management, managed care, healthcare operations, network management, contracting, or a related healthcare field requiredWorking knowledge of government-sponsored healthcare programs, including Medicare and Medicaid, and their impact on provider operations, reimbursement, eligibility, and regulatory requirements preferredPrior experience in Provider Relations, Provider Network Management, Account Management, Contracting, or a related healthcare function preferred
Pay Range: USD $37.32 - USD $46.66 /Hr.
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