- Develops and retain effective relationships with physician and business leadership of key physician groups and delivery systems within designated geographic area(s) to drive business results.
- Act as resource for others with less experience.
- Responsible for more complex and high priority contracted health systems.
- Conduct regular service visits to ensure provider service needs are met, resolve issues, educate providers and provider staff on policies and the web-portal usage, collect credentialing information, and review Healthcare Effectiveness Data and Information Set (HEDIS) information, etc.
- Respond to incoming provider inquiries from assigned providers and resolve issues. Assist colleagues with complex provider inquiries.
- Implement and/or provide ongoing relationship management for large, high profile physician groups, Independent Practice Associations (IPAs), and hospital systems with positive business results.
- Coordinate exchange, data updates, and follow-up of credentialing delegation rosters, provider file related functions, and provider rates implementation initiatives.
- Provide delegated provider with quarterly roster participating providers and oversee audits for accuracy.
- Manage delegated roster submission and assure timely receipt and loading into provider database.
- Contract with community and hospital based physicians and ancillary providers.
- Bachelor's Degree in health care administration, business or an equivalent combination of education and work experience in managed care or health care.
- Minimum of five years' experience in health care; including a minimum of three years in provider/ payor contracting.
- Extensive experience in developing contract types, fee arrangements and other contract terms and in developing and recommending potential solutions to contract issues.
- Proficiency in Microsoft Office software (Word, Access, Excel).
- Ability to travel efficiently and continuously to and within assigned geographic area.
- Strong organizational and project management skills.
- Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
- Demonstrate appropriate behaviors in accordance with the organization's vision, mission, and values.
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Pyramid Consulting, Inc Bethpage, United StatesImmediate need for a talented Network Operations Representative. This is a 12+ Months Contract opportunity with long-term potential and is located in Bethpage, Long Island, NY(Onsite). Please review the job description below and contact me ASAP if you are interested. · Job ID: · ...
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Elevance Health Woodbridge Township, United States Full timeJob Description · : Network Management Representative · Location : This is a remote position. Ideal candidates will live within 50 miles of an Elevance Health PulsePoint office location in California, Colorado or in the Eastern time zone. · A proud member of the Elevance He ...
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Omega Innovations York, United StatesAbout WS Süd GmbH Tax Consulting Company: · WS Süd GmbH was established in Jetzt bewerbenas a management buyout (formerly Ernst & Young AG, location VS). In addition to our headquarters in Villingen-Schwenningen, we are now also represented in Tuttlingen and Bad Dürrheim and prov ...
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Quantum Dynamics York, United StatesOur client is a medium-sized German technology company based in Hamburg with multiple locations throughout Germany. The company employs around 300 employees and specializes in innovative technological solutions. · We are currently seeking a Chief Information Officer / CIO (m/f/d) ...
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Senior Technical Writer
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Elite Model Management, USA New York, United States" · Company Description · Elite New York was founded in 1977 by John Casablancas. At its inception, Elite revolutionized the modeling industry by giving birth to The Supermodel. Forty-five years later, Elite continues to be revered as one of the most powerful agencies not only in ...
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Senior Network Engineer
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Iceberg Cyber Security New York, United StatesI'm currently representing a global tech organisation whose base of operations is in New York and this year they have grown strength to strength in investing heavily in their platforms and tech stack. With this level of innovation, the senior leadership have identified the need f ...
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Molina Healthcare New York, United States Full timeJOB DESCRIPTION · Job Summary · Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal cu ...
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Physician (MD/DO) - Pathology in New York
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All Star Healthcare Solutions New York City, United StatesPathology need between Albany and Syracuse New York · Job ID 71447 · Job details: · BC/BE in AP/CP · Replace a retiring member of an established group of five pathologists covering the Anatomic and Clinical Pathology needs of the entire integrated network · Primary duties are ana ...
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Cubiq Recruitment New York, United StatesRole: MSP Support Technician · Location: New York, NY - Manhattan-based · Salary Range: $65,000 - $75,000 · **************** INTERVIEWING NOW********************** · Cubiq is excited to be representing one of the largest and most technically advanced MSP in New York, supporting t ...
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Ryan-chelsea Clinton Community Health Center New York, NY, United States Full timePosition Overview: · Manage all aspects of the day-to-day operations of the clinical services, including clinical and administrative supervision of Licensed Practical Nurses and Certified Medical Assistants. Scheduling patients, and monitoring patient flow. This work is carried ...
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Territory Sales Manager
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Submarine/Subsea Cable Program Manager
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Associate Attorney
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Senior Scientific Lead, Large Molecule Biology
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Lilly New York, United States Full timeWe're looking for people who are determined to make life better for people around the world. · About · aims to create medicines that make life better for all those affected by cancer around the world. Bringing together the focus and spirit of a biotech with the scale, resources ...
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Network Design Engineer
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Pinnacle Group New York, United StatesJob Title: Network Design Engineer 2 · Location: Groton, CT (onsite) · Duration: 12+ months · Pay Rate: $50 - $55 /hour on W2. · **Must be able to work on W2 without sponsorship ** · Job Description: · We are primarily looking for someone who can come in to learn the environme ...
Senior Provider Network Representative - New York, United States - Amida Care
Description
Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement, and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member.
We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit for more information about the Amida Care culture.
We are actively seeking a highly motivated, innovative, and experienced leader to join our team as the Senior Provider Network Representative. Compensation will be commensurate with experience.
Position Summary:
This position develops, contracts, maintains, and enhances relationships with key high volume facilities and physicians to drive business results. This position is responsible for the appropriate representation of providers relating to contractual arrangements, compliance, regulatory, credentialing, claims, provider files and administrative policy and procedures. This position may be assigned to service sponsors and/or other large provider entities, possibly in multiple boroughs.
Responsibilities:
Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.
EDUCATION REQUIRED
EXPERIENCES AND/OR SKILLS REQUIRED
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