Assistant Manager - Provider Network Management
: Job Details :

Responsibilities • Develop and oversee provider education, recruitment, and intervention efforts for 1199SEIU Funds • Oversee Provider Relations Representatives (Field and In-House) assigned to territories in the Funds Network; conduct site visit verification to ensure Provider Relation Representatives are meeting site visits goals and expectations • Handle escalated issues (i.e. recruitment requests, enhanced fee negotiations requests, provider complaints, appeals, claim files) • Manage the Home Care Fund plan including roster distribution; ensure providers are knowledgeable of Funds programs and policies • Assist with implementation of cost containment programs • Generate reports including Executive reports to track staff performance; meet with staff regularly; coach and mentor staff to ensure network management goals and initiatives are met • Assess training needs and develop plans to ensure staff are trained on policies and procedures, and new programs • Perform additional duties and projects as assigned by managementQualifications • Bachelor's Degree in a related field; or the equivalent years of experience required • Minimum four (4) years experience with provider recruitment, contracting and credentialing, to include a minimum of two (2) years supervisory experience required • Experience in a healthcare plan or managed care setting • Knowledge of healthcare management systems, healthcare terminology, medical billing, reimbursement payment structures and Medicare terminology • Proficiency in Microsoft Office; able to navigate web-based systems • Excellent interpersonal and communication skills - oral, written and listening • Strong organizational skills with ability to work in a fast-paced environment and juggle multiple competing tasks and demands • Excellent customer service skills; able to build and maintain relationships, and diffuse difficult situations • Demonstrated leadership skills with ability to interact and communicate with individuals at all levels of the organization in a professional manner. • Must have high ethical standards to handle sensitive and confidential situations. Position continually requires demonstrated integrity, honesty, poise, tact, and diplomacy. • Must be able to travel throughout New York and New Jersey