Job Ref: 112891
Category: Professional
Department: PROVIDER CONTRACTING
Location: 50 Water Street, 7th Floor,
New York,
NY 10004
Job Type: Regular
Employment Type: Full-Time
Hire In Rate: $53,800.00
Salary Range: $53,800.00 - $63,800.00
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.
MetroPlusHealth 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'snetwork 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 Overview
Provide technical administrative support for all network development and contracting activities. The primary focus of the position will be on outreach, recruitment, and contracting of Behavioral Health providers.
Research and Prepare provider contracts after credentialing is completed in Contract Lifecycle Management System (CLM).
Build and maintain relationships internally and externally and work with integrated and matrix partners.
Understand contract lifecycle, negotiation, and provider engagement.
Communicate to Managers, providers, and appropriate decision makers any practices, policies and procedures that create inefficiencies.
Reconcile any reporting errors and make updates in Credentialing and Contracting systems as needed.
Develop reports across various functional areas to measure process-outcome relationships and recommend necessary process adjustments.
Assist with the generation of monthly Provider Network reports (BH Exhibit 4/C/MAP) as well as ad hoc reports as needed.
Work with Contract Administrators to prepare and submit contracts to Contract Core Configuration (CCC) system.
Create data visualizations of various complexities to communicate insights, opportunities, and risks to different audiences.
Maintain the Behavioral Health Network contracts and provider supporting data.
Investigate discrepancies in expected outcomes and conduct root cause analysis for terminating Providers.
Make the appropriate systems updates to reflect provider contract status. Update contracting information in Cactus and Contracting Database (amendments, terminations, etc.).
Outreach providers for Network growth and development assignments as applicable or when requested.
Build relationships with provider community to foster growth in Behavioral Health and Physical Health Networks.
Conduct analyses and assignments with accuracy and consistency when required.
Work on special projects as needed, and assist in all areas of the Provider Contracting Department
Identify network need, recruit, and contract providers/facilities to meet and maintain regulatory network compliance.
Bachelor’s Degree, preferably in Health Care Administration, Business Administration, or other related area of study.
Minimum of two years’ experience with a managed care plan and good working knowledge of managed care concepts and organizational functions.
Experience with Tableau, Salesforce, Cactus is a plus, but not necessary.
Proficient in computer applications including MS Office including Word, Excel, and Access.
Excellent organization and project management skills.
Professional Competencies
Integrity and Trust
Customer Focus
Functional/Technical skills
Written/Oral Communication
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