Director of Provider Relations
Company: Metroplus Health Plan
Location: New York
Posted on: June 25, 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 +
HospitalsMetroPlusHealth 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,
MetroPlusHealth's network includes over 27,000 primary care
providers, specialists and participating clinics. For more than 30
years, MetroPlusHealth has been committed to building strong
relationships with its members and providers to enable New Yorkers
to live their healthiest life. Position OverviewThe Director of
Provider Relations is responsible for the management and oversight
of the provider relations team, including but not limited, to the
management of goals and metrics, departmental and cross functional
processes as well as ongoing improvement activities. This position
develops, implements and oversees strategies and policies and
procedures for building collaborative relationships with providers
through provider education, training, regulatory compliance and
resolving operational issues. Job DescriptionAct as a key resource
to external providers and internal key stakeholders as it pertains
to operational issues impacting provider satisfaction. Improve the
provider experience, in coordination with providers and with the
plan through focused education and training, performance reporting,
effective communication of new products, benefits, policies or
initiatives, and resolution of provider issues across the business.
Lead joint quarterly and monthly meetings to review progress and
performance opportunities with leadershipEnsure timely responses to
regulatory agencies (i.e., NYSDOH, DFS) in response to all Provider
Network regulatory and compliance issues.Develop guidelines and
measures for provider relations that align with corporate goals and
measures.Review and identify trends on call volume received across
all provider segments as well as any complaints received; leverage
data to implement strategies to further enhance provider plan
experience.Responsible for developing and updating trend
reporting/dashboards/issues trackers.Create strategies to improve
key performance indicators; analyze performance data and identify
opportunities and performance drivers.Work cross organizationally
to ensure successful implementation of provider performance
programs and agreements.Ensure data integrity of provider
directory, web search, etc.Develops processes to educate new and
existing providers regarding their contractual responsibilities as
well as policies and procedures. Monitor provider concerns,
collaborate and consult with internal leaders and department to
improve operations and resolve issues impacting provider
satisfaction and payment. Participates in cross-functional
workgroups to understand impact of plan changes and initiatives on
provider network, advocating for providers as appropriate.Working
collaboratively with Account Management Team, build strong
partnership with provider community by cultivating open
communication and ensuring Account Leads are aware of provider pain
points relative to claims disputes. Facilitate with marketing and
retention department management to identify opportunities in
current provider locations and cultivate them in viable prospects
to increase MetroPlusHealth enrollment and retention
efforts.Develops policies and procedures, process improvement
initiatives.Direct and mentor staff to ensure job functions are
completed appropriately and according to priorities.Coach team
members in the use of data and appropriate analytical tools that
support improved quality.Support team members in the identification
and creative problem resolution for improved processes and expanded
use of technology.Ensures department staff remains current in all
aspects of Federal and State rules, regulations, policies and
procedures and creates or modifies departmental policies to reflect
changes. Systematically keeps staff informed of policy and
procedural changes affecting program and administrative
operations.Responsible for department staffing decisions and
providers supervision to assigned staff, writes and performs annual
reviews and monitors performance issues as they arise. Responsible
for hiring and training process including recommendations regarding
staff retention, termination and succession planning.Coordinates
department's efforts with those of other departments.Performs other
support activites and duties as assigned.Minimum
QualificationsBachelor's degree, preferably in health care
administration, and a minimum of 5-7 years experience in a managed
care government program claims processing/analyzing experience,
working with facilities in addressing reimbursement issuesMaster's
degree in Health Administration preferredKnowledge of principles of
business and personnel administration, management functions and
support service functions and ability to direct and supervise
personnelProficient with Windows-based PC systems and Microsoft
Office, SharepointEnergetic, goal driven leader with who can
motivate and mobilize staff to achieve goals. A strategic thinker
who can assess implications and formulate plans of actionStrong
problem-solving capabilitiesAbility to streamline and improve
operational processes and metricsAbility to display a high degree
of professionalism, initiative and excellent judgement in making
decisions regarding contractual issues and dealing with politically
sensitive situations. Strong relationship building skills to
influence and work collaboratively with physicians, hospitals,
business leaders and internal departments. Proven ability to
balance execution of the strategic vision through leadership and
delegation with a willingness to dive into the details as
requiredDemonstrated interpersonal skills (including oral and
written) to interact effectively with a diverse range of internal
and external constituents, stakeholders, and audiences. A high
level of diplomacy to anticipate, recognize and address effectively
with politically sensitive issues.Willingness to challenge the
status quo and implement creative solutions to inefficient
processes. Ability to manage multiple projects simultaneouslyDrive
for Customer SuccessBuild Relationships & Cultivate NetworksHighly
organized, detail oriented, dependable and professional
individualAbility to travel to meet with Providers and their
representativesProfessional CompetenciesIntegrity and TrustCustomer
FocusFunctional/Technical skillsWritten/Oral Communication
Keywords: Metroplus Health Plan, New York , Director of Provider Relations, Executive , New York, New York
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