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About the Role

Amida Care is seeking a Senior Provider Network Representative to develop, contract, maintain, and enhance relationships with facilities and physicians to drive business results. This role is responsible for provider representation concerning contractual arrangements, compliance, regulatory matters, credentialing, claims, provider files, and administrative policies.

Responsibilities

Develop 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.
Mentor team members and manage escalations effectively, taking responsibility 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 staff on policies and web-portal usage, collect credentialing information, and review HEDIS information.
Respond to incoming provider inquiries and resolve issues, assisting colleagues with complex inquiries.
Implement and/or provide ongoing relationship management for large, high profile physician groups, 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.
Manage the delegated provider roster process, ensuring accuracy and timeliness of data processing.
Contract with community and hospital-based physicians and ancillary providers.
Perform duties related to regulatory compliance and applicable organizational requirements.
Facilitate and manage Single Case Agreements as required.
Conduct monthly calls to the provider network to ensure compliance with IPRO/Access and Availability.
Identify potential claims and systems trends, and correct root causes for the organization's provider systems data issues.
Monitor contracts to ensure contract administration objectives are achieved and oversee provider data quality assurance.
Chair regular contract relations meetings with key groups.
Coordinate contract management strategies with hospital and ancillary leads to ensure appropriate coordination of the organization's network strategy.
Assist with the development and execution of strategies for member growth and achievement of medical cost targets.
Perform other duties as assigned.

Requirements

Minimum of five (5) years' experience in health care.
Minimum of three (3) years in provider/payor contracting.
Extensive experience in developing contract types, fee arrangements and other contract terms.
Experience in developing and recommending potential solutions to contract issues.
Ability to travel efficiently and continuously to and within assigned geographic area.
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.

Skills

Proficiency in Microsoft Office software (Word, Access, Excel).
Strong organizational skills.
Strong project management skills.

Location

New York

Work Type

Full-time

Experience Level

Senior

Education Level

Bachelor’s degree in health care administration, business or an equivalent combination of education and work experience in managed care or health care.

Salary/Compensations

Commensurate with experience

About the Company

Amida Care is the largest Medicaid HIV Special Needs Plan in NY, delivering 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 Amida Care [http://www.amidacareny.org/] for more information about the Amida Care culture.

Equal Opportunity

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.