Requisition #:

6780

# of openings:

1

Employment Type

Full time

Position Status

Permanent

Category

Non-Bargaining

Workplace Arrangement

Hybrid

Fund

1199SEIU National Benefit Fund

Job Classification

Exempt

Responsibilities

Develop and o versee 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 management

Qualifications

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