This position has day to day responsibility of managing the relationships that supports the EmblemHealth hospital network in downstate NY. There is daily, directly interaction with Emblemhealth’s hospital network, assisting in resolving operational issues, and educating providers on Emblemhealth policies, procedures and processes.
•Responsible to respond to issues reported by participating facility providers timely, accurately and report reoccurring or systemic issues to Manager. Detailed review of claims, grievances, and other issues is required.
• Track and report on issues researched for participating providers including validation of financial impact for the purposes of reserving sufficient dollars.
•Supports the Departmental Service Model with specific function(s) as assigned by Manager.
•Assist in training participating facilities on Emblemhealth policies, procedures and payment guidelines, website, and any other training needs that may arise.
•Works closely with operational areas such as UM, Claims and GAD to ensure compliance with facility agreements.
•Plan for, coordinate and facilitate meetings with participating facility providers. Report and track outcomes of meetings and follow up to ensure assigned tasks are completed and reported appropriately.
•Special projects as assigned.
•Regular attendance is an essential function of the job. Performs other duties as assigned or required.
Knowledge, Skills & Abilities:
•Excellent follow-up skills with both internal and external partners.
•Excellent analytical and problem solving skills utilizing both an individual and team approach.
•Attention to detail.
•Strong verbal and written communication skills.
•Expertise leading group discussion with internal and external partners.
•Ability to work independently and function effectively under pressure of tight deadlines and multiple initiatives.
•Ability to anticipate and communicate regarding potential barriers in a timely fashion.
•BS required in Business Administration, Health Care Administration, Finance or related degree.
•3-5 years prior experience (managed care, health administration or health education).
•3-5 years prior experience (contracting, provider and/or vendor management).
Internal Posting Closing Date: 1/31/13
Group Health Incorporated (GHI) - 18 months ago
EmblemHealth is set on being the mark of good health in the Northeast. The not-for-profit company provides health...