Network Management Representative
Healthfirst - New York, NY

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The Network Management Representative is Healthfirst's first impression and lead contact for hospitals, physicians and physician groups. This includes developing and nurturing these relationships guaranteeing mutual goals are achieved.

Healthfirst is a paperless work environment requiring daily hands-on administration of multiple proprietary and packaged electronic databases including security requirement tools such as encryption. These systems include, but are not limited to, scheduling appointments in Outlook, Sunguard Macess Service Module for electronic archiving, e-fax, VoIP, and Virtual Work Platforms (using VPN).

Essential Duties and Responsibilities:
  • Serve as plan liaison for physicians/physician groups in a specified geographical area. Will be main point of contact for all plan-related issues including marketing, enrollment, contracting, billing and reimbursement. Responsibility for the resolution of all issues, including those identified by the provider, and those identified internally that have an impact on the physician. Coordinates with all Healthfirst staff to assist as appropriate, including creating project plans, issue logs, conference calls, etc.
  • Responsibility for the recruitment process.
  • Identify gaps, paperwork, etc.
  • Schedule frequent and regular face-to-face contact with the practice locations to identify any issues and ensure plan visibility.
  • Keep abreast of competitor activity, including new reimbursement and marketing strategies. Negotiate favorable/competitive rates with providers based on market trends.
  • Conduct new provider orientation and identify on an ongoing basis opportunities for education on both clinical and administrative topics. Includes experts in the field of education as needed from in-house staff.
Other Duties and Responsibilities:
  • Working under light supervision, maneuvers multiple tasks independently with a fast-paced proactive vs. reactive approach to changing priorities while meeting departmental objectives.
  • Attention to managing many details and remaining focused in an environment with distractions.
  • Contribute creative solutions and ownership of daily assignments for seamless communication and systematic completion of routine and special projects.
  • Follow protocols and use common sense to escalate situations to management appropriately.
  • Handle other duties as assigned with the occasional need to work weekends, overtime and/or travel throughout the tri-state area.
  • Engage in mastering the Division's impact on Healthfirst, its Members and Providers.
Qualifications Summary:
Education:
Required: High School diploma or GED.

Preferred: Bachelor’s degree.

Licenses, certificates, etc.

Required: Valid driver's license

Work Related Skills and Experience:
Minimum Qualifications:
Technical Skills :
Intermediate Microsoft Word, Excel and experience using a corporate e-mail system (i.e. Microsoft Outlook, Lotus Notes, etc.) skills are required.

Experience:
  • Minimum one year of healthcare or public relations experience required.
  • Valid driver's license and automobile required.
  • Intermediate MS Word, Excel, and Outlook skills.
  • Excellent oral and written communication skills.
  • Ability to work independently in a demanding fast-paced environment.
  • Ability to prioritize and multi-task.
  • Strong time management skills.
  • Strong problem-solving skills coupled with ability to facilitate resolution to issues.
  • Strong sense of urgency and self-motivational qualities.
Preferred Qualifications:
Technical Skills :
Intermediate MHS, MACESS or electronica archiving skills are preferred.

Experience:
  • Medicare and/or Medicaid managed care experience.
  • Experience with MHS, MACESS, and/or electronic archiving.
Physical Demands:
While performing the duties of this job, this employee will be bending, overhead lifting and lifting/carrying and pushing/pulling 1-20lbs. This employee will be frequently walking, sitting, keying, balancing, standing and driving.

Work Environment :
This employee will frequently be indoors, outdoors, hot and cold.

Healthfirst offers a comprehensive benefits package including, but not limited to:

  • Medical
  • Dental
  • Vision
  • Basic Life and Accident Insurance
  • Supplemental Life insurance
  • Dependent Life Insurance
  • Short-Term Disability
  • Buy-Up Short Term Disability
  • Long-Term Disability
  • Flexible Reimbursement Accounts
  • Healthfirst 401(k) Plan
  • Employee Assistance Plan
  • Commuter Savings Program
  • Eligibility for Annual Bonuses
  • Generous Paid Time Off program
  • Paid Candidate Referral Program
Conditions of Employment: Employee must pass pre-employment screening which includes a background check and drug testing. Employee must present documentation to verify minimum of high school educational requirement.

Disclaimer: The statements herein are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, national origin, disability or veteran status .

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Healthfirst is a not-for-profit managed care organization sponsored by some of the most prestigious and nationally recognized hospitals and...