Senior Director of Provider Network Operations
Company: MetroPlus Health Plan
Location: New York
Posted on: May 16, 2022
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Job Description:
Empower. Unite. Care. MetroPlusHealth is committed to empowering
New Yorkers by uniting communities through care. We believe that
Health care is a right, not a privilege. If you have compassion and
a collaborative spirit, work with us. You can come to work being
proud of what you do every day.About NYC Health +
HospitalsMetroPlus Health provides the highest quality healthcare
services to residents of Bronx, Brooklyn, Manhattan, Queens and
Staten Island through a comprehensive list of products, including,
but not limited to, New York State Medicaid Managed Care, Medicare,
Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold,
Essential Plan, etc. As a wholly-owned subsidiary of NYC Health +
Hospitals, the largest public health system in the United States,
MetroPlus Health' s network includes over 27,000 primary care
providers, specialists and participating clinics. For more than 30
years, MetroPlus Health has been committed to building strong
relationships with its members and providers to enable New Yorkers
to live their healthiest life.Position OverviewThe Senior Director
of Provider Network Operations oversees all aspects of the provider
operations, provider relationship management, provider education,
provider enrollment, credentialing, provider data integrity and
provider regulatory compliance. The Senior Director is a strong
advocate for provider focus for the enterprise as well as provider
relations and seamless provider operations.Job DescriptionOversee
staff that has day to day responsibility for managing the
relationships that supports the MetroPlus Health Provider Network,
serving as escalation point for internal staff and external
contacts regarding resolution of highly complex or unusual business
problems that affect major contract functions, performance, or
relationships. Ensures provider education (new provider
orientation, on-going provider visits and meetings, etc.,)
activities are done in a timely and cost-effective manner to
continuously improve relationships with network providers. Ensure
that relationships with providers are appropriately monitored and
maintained to drive high provider satisfaction Meet regularly with
providers at Joint Oversight Committee meetings to address all
financial, operational, quality and contractual issues. Monitors
and reviews provider satisfaction results and makes recommendation
for improvements Collaborates with internal departments to assess
provider experience and identify areas of opportunity Ensure timely
responses to regulatory agencies (i.e., NYSDOH, DFS) in response to
all Provider Network regulatory and compliance issues Keeps abreast
and maintains familiarity with industry and government program
(Medicare and Medicaid) trends, regulations, legislation, and
payment rules and reimbursement methodologies. Builds a
high-performance environment and implements a people strategy that
attracts, retains, develops and motivates their team by fostering
an inclusive work environment and using a coaching mindset and
behaviors; communicating vision/values/business strategy; and
managing succession and development planning for the team. Manages,
trains, coaches, and develops staff across the Provider Network
Operations departments Develops staffing models and monitor
capacity/capabilities of teams across the Provider Network
Operations departments Leads Teams in a manner that promotes the
ongoing growth and expanded knowledge of associates Establishes and
reports key metrics to track department performance Supports team
members in the identification of operational barriers and creative
problem resolution for improved processes and expanded use of
technology Work with all parties to adequately address and resolve
data discrepancies to reduce financial and compliance risks to the
plan Provide performance improvement reports based on analyses of
compliance and/or audit findings Develop and implement approved
modifications to workflows, policies and procedures to improve
performance Oversees the research, analysis, and resolution of
complex problems with claims development and finalization. Support
Account Management team with regular and ad-hoc provider data
requests Conducts special projects including business analyses,
strategic planning, and implementation efforts on new business
acquisitions and changing corporate requirements. Manages the
overall budget in support of the responsibilities of the areas and
corporate initiatives and responsibilities. Perform other
responsibilities as assignedMinimum QualificationsMaster's Degree
in public health, business, or related field. Managed care
experience preferred. Minimum of 10 years of combined network
management, credentialing or regulatory affairs with increasing
responsibility including staff management experience, operations,
claims preferably in a managed care or insurance environment. An
equivalent combination of training, education and experience in
related fields and educational disciplines. Familiarity with
provider community and health care marketplace trends and superior
knowledge of NYS hospital reimbursement and managed care laws and
regulations. Data management, data analytics, quality assurance,
and project management skills required. Ability to efficiently
standardize and reconcile disparate data effectively. Strong
quantitative skills, including the ability to identify
trends/analyze. Effective oral, written, and interpersonal
communication skills required. Professional Competencies:Integrity
and Trust Customer Focus Functional/Technical Skills Written/Oral
Communications
Keywords: MetroPlus Health Plan, New York , Senior Director of Provider Network Operations, Executive , New York, New York
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