Job Information
Healthfirst Ancillary Srvs Contractor in Hybrid, New York
Manage a network of Ancillary Providers for all lines of Healthfirst's business (such as Medicaid, CHP, Medicare, and Commercial).
Monitor and audit contracted ancillary providers to ensure that accurate demographic, payment and fee schedules are loaded into the HF Provider System correctly
Resolve configuration issues by identifying root causes to prevent claims denials and to ensure claims are paid correctly
Facilitate meetings cross-departmentally to achieve positive outcomes in management of ancillary provider network
Create contracts in HF contract software and review credentialing documents submitted by Provider/facility via Universal Credentialing Data Source, The Council for Affordable Quality Healthcare (CAQH) or PDF application to ensure that all the required credentials are included and that valid documents for behavioral Providers and facilities are provided
Negotiate and execute Single Patient Agreements for Out of Network (OON) Providers in order todetermine the Provider's payment arrangement
Individual should be familiar with contracting and reimbursement methodologies for ancillary services providers
Educate newly credentialed Providers on Healthfirst's policies and procedures such as billing and authorization requirements, utilization of Healthfirst's Provider portal, claims submission, etc., via various methods (telephonic, face-to-face, webinar, etc.
Analyze provider network based on monthly report to ensure that Plan is meeting Health Plan Network (HPN) State requirements
The individual would work closely with Network Management, Credentialing, and the business analytics unit within the Ancillary department, to complete the analysis
Identify root cause of claims issues and facilitate resolution by working closely with Reimbursement and Claims departments
Clearly communicate resolutions and progress to the Providers
Assist Appeals and Grievances (A&G) department by acting as liaison between Providers and A&G department to achieve favorable outcomes of member related issues, complaints, balance billing and other issues
Ensure that all Providers inquiries received via email and phone call are addressed efficiently and effectively within required timeframe
Assist management with research and facilitation of projects related to contract updates, new product implementation and new reimbursement methodologies
Additional duties as assigned
Minimum Qualifications:
HSD/GED equivalent
Experience managing or performing high level servicing to a portfolio of customers/providers
Contracting experience
Ability to work independently in dynamic environment
Ability to take initiative and work independently
Ability to prioritize and multi-task
Strong customer-centric and analytical skills
Strong sense of urgency and self-motivational qualities
Excellent oral and written communication skills
Preferred Qualifications :
- Bachelors Degree
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.