Military Spouse Connection Jobs

• Assists in the development and recruitment of the Behavioral Health networkbased on department needs and Healthfirst priorities.

• Negotiates and executes Single Patient Agreement for Out of Network providers in order to determine the providers payment arrangement. Individual must be familiar with or have the ability to learn contracting and reimbursement methodologies for inpatient and outpatient services.

• Conducts comprehensive provider network training onsite, through webinars, or at off-site provider locations that will support network providers in gaining appropriate knowledge, skills and technical expertise ultimately ensuring providers understand and are compliant with managed care requirements.

• Organizes provider training materials and education of BH providers ensuring that providers understand anynew services or initiatives including the following: Behavioral Health- Home and Community Based Services (HCBS), Recovery Coordination Agencies, Childrens Family Treatment and Support Services. Responsible for the creation of various Microsoft PowerPoint presentations and other documents. Educate providers on Healthfirst policies and procedures such as billing, authorization, utilization of Healthfirsts provider portal, claims inquiries, etc.

• Conducts initial provider orientation. This orientation is also available periodically via webinar.Topics will include: expanded array of benefits, Health Homes, Claims, Authorizations, Cultural Competency, Evidence Based Practices, Utilization Management, HCBS eligibility/assessment and the secure provider portal.

• Assists in obtaining credentialing documentation for new providers, distributes and collects executed contracts, distributes provider communication and provides network maintenance to ensure access and availability standards such as travel time/distance to BH Providers, are adequate and compliant.

• Reviews provider issues and performs root cause analysis by operating in an analytical framework, resolving providers issues and ensuring timely and positive outcomes.Appropriately escalates critical and other concerns that theProvider may have in order to resolve issues accordingly. Provides internal support for the resolution of operational problems as they pertain to the contracting process, claims payments and/or BH provider contracts.

• Participates in meetings by providing analysis, feedback and recommendations that foster a successful relationship between Healthfirst, external agencies and essential providers.

• Monitors and conducts regular audits as needed of contracted behavioral networks to ensure that accurate information such as demographics, payment and fee schedules are loaded into Healthfirsts systems appropriately. Resolves configuration issues when identified to prevent further claim denials.

Minimum Qualifications:

• High School Degree/GED

• Experience and understanding of health care reimbursement methodologies

• Knowledge of Medicare and Medicaid products

• Must have either: Behavioral Health, network development, provider relations or provider education experience

• Ability to travel to various NY boroughs as needed (car not required)

• Experiencewith Microsoft Outlook or similar calendar management,

• Demonstrated ability to multi-task, prioritizeanduse good judgementin a fast-paced environment

Preferred Qualifications:

• Bachelors Degree

• Previous experience in a managed care environment working closely with providers

• Ability to take initiative and work independently in a dynamic environment

• Strong customer-centric and analytical skills

• Excellent oral and written communication skills

• Strong presentation and problem-solving skills

• Valid driver's license and insured automobile

• Familiar with root cause analysis

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.