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New York City

    Analyst - Travel - New York, NY, United States - MetroPlus

    MetroPlus
    MetroPlus New York, NY, United States

    2 weeks ago

    Default job background
    Full time
    Description
    Care.

    MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. About NYC Health + Hospitals


    MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.

    As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics.

    For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.


    The Manager of Provider Relations will serve as the point person for managing the day-to-day relationship between MetroPlusHealth and top level-administrators at each assigned network facility and community providers.

    Responsible for overall provider satisfaction regarding assigned network segment and will manage respective network support team.


    All qualified applicants will be expected to report in-office twice a week in our 50 Water Street, New York, NY location.


    Act as a key resource to external providers and internal key stakeholders as it pertains to operational issues impacting assigned network segment.

    Develop and implement educational processes and pro-active solutions for payment and other provider operations requirements as well as access & availability concerns

    Reviews reports on annual provider satisfaction surveys; work with other departments to develop quality assurance initiatives based on survey results.

    Ensure segment's data integrity of provider directory, web search, etc.,
    Monitor/Trend Provider calls received as well as any complaints received for responsible segment
    Develops processes to educate new and existing providers regarding their contractual responsibilities as well as policies and procedures.

    Monitor provider concerns, collaborate and consult with internal leaders and department to improve operations and resolve issues impacting provider satisfaction and payment.

    Participates in cross-functional workgroups to understand impact of plan changes and initiatives on provider network, advocating for providers as appropriate
    Ensure timely responses to regulatory agencies (i.e., NYSDOH, DFS) in response to all Provider Network regulatory and compliance issues
    Coordinate events with the community/government agency offices within assigned network

    Working collaboratively with Account Management Team, build strong partnership with provider community by cultivating open communication and ensuring Account Leads are aware of provider pain points relative to claims disputes.

    Develops policies and procedures, process improvement initiatives
    Manage and mentor staff to ensure job functions are completed appropriately and according to priorities
    Performs other support activites and duties as assigned


    Bachelor's degree, preferably in health care administration, and a minimum of 5 years experience in healthcare, plan or provider operations/administration/ relations or related area.

    Managed care, value-based payment model, quality and population health management experience
    Proficiency with Windows-based PC systems and Microsoft Office, SharePoint
    Ability to travel to meet with Providers and their representatives

    Energetic, goal driven leader with who can motivate and mobilize staff to achieve goals.
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