Provider Partnership Specialist

Overview

Manages a lower-complexity portfolio of contracted and prospective providers with general supervision. Serves as a primary provider contact for service, recruitment, contracting, implementation and issue resolution; leads straightforward negotiations using approved rates and standard terms; and supports provider performance and improvement initiatives.

Responsibilities

expand with demonstrated proficiency, with exceptions and higher-risk matters escalated to the manager. What We Provide Referral bonus opportunities Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability Employer-matched retirement saving funds Personal and financial wellness programs Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care Generous tuition reimbursement for qualifying degrees Opportunities for professional growth and career advancement Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities What You Will Do Manages assigned provider relationships and day-to-day service needs, prioritizing requests and maintaining ownership of issues and commitments through resolution.

Recruits providers and lead straightforward contract negotiations, repapering and other assigned contracting activities using approved rates and standard terms. Coordinate implementation and escalate exceptions or matters beyond assigned authority. Investigates and resolves provider issues involving claims and billing, credentialing, provider data, authorizations, utilization management, quality, compliance, member service and contract implementation, partnering with internal teams as needed.

Leads standard provider onboarding, orientation, education, system access and contract implementation; coordinate responsibilities, information and deadlines across providers and internal departments. Prepares for and lead provider operating discussions; communicate policies, performance expectations, corrective actions and available tools, and review account, claims, roster, attribution and service data to identify issues and improvement opportunities.

Supports value-based payment arrangements and provider performance initiatives, including Stars, HEDIS, compliant risk adjustment, medical cost, quality, access and member experience, through education, data exchange, action planning and performance tracking. Coordinates assigned regulatory and compliance activities, including provider attestations, Model of Care training, delegated oversight, accreditation or audit requests and corrective-action follow-up.

Leads defined initiatives or assigned portions of larger projects, maintaining plans, responsibilities, deadlines and decisions and escalating barriers when needed. Maintains complete and timely provider account, contracting, issue and outcome records in designated systems; report risks and complete assigned mitigation actions.

Applies feedback and developing knowledge of managed care, reimbursement and provider performance to take on increasingly complex provider work. Exercises judgment with general supervision for lower-complexity provider work. Resolves day-to-day provider matters and agrees to operational resolutions, implementation plans, education and corrective actions within assigned authority.

Leads straightforward negotiations using approved parameters and escalates nonstandard terms, significant risks and decisions outside delegated authority. Remains accountable for assigned provider relationships through contracting, implementation and ongoing service, including timely follow-through when work depends on other departments.

Participates in special projects and performs other duties as assigned.

Qualifications

Bachelor's Degree in healthcare administration, business, public health, health services, communications, education, psychology or relevant work experience required Work Experience: Ability to evaluate information, communicate clearly, organize work and follow through on commitments required Demonstrates sound judgment, readiness to learn managed care concepts and an understanding of when to seek guidance required Communicates clearly in writing, meetings and presentations.

Uses facts and sound reasoning to explain recommendations and gain cooperation required Works effectively when information is incomplete or priorities change. Handles conflict and difficult conversations professionally required Adjusts work hours occasionally to accommodate provider meetings and business needs required Experience supporting Medicare, Medicaid, dual-eligible, managed long-term care or other government-sponsored healthcare programs, or experience in a provider practice or provider administration environment preferred Pay Range USD $66,300.

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• USD $72,000.00 /Yr.

About Us

VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We’re one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.

What We Provide Referral bonus opportunities Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability Employer-matched retirement saving funds Personal and financial wellness programs Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care Generous tuition reimbursement for qualifying degrees Opportunities for professional growth and career advancement Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities What You Will Do Manages assigned provider relationships and day-to-day service needs, prioritizing requests and maintaining ownership of issues and commitments through resolution.

Recruits providers and lead straightforward contract negotiations, repapering and other assigned contracting activities using approved rates and standard terms. Coordinate implementation and escalate exceptions or matters beyond assigned authority. Investigates and resolves provider issues involving claims and billing, credentialing, provider data, authorizations, utilization management, quality, compliance, member service and contract implementation, partnering with internal teams as needed.

Leads standard provider onboarding, orientation, education, system access and contract implementation; coordinate responsibilities, information and deadlines across providers and internal departments. Prepares for and lead provider operating discussions; communicate policies, performance expectations, corrective actions and available tools, and review account, claims, roster, attribution and service data to identify issues and improvement opportunities.

Supports value-based payment arrangements and provider performance initiatives, including Stars, HEDIS, compliant risk adjustment, medical cost, quality, access and member experience, through education, data exchange, action planning and performance tracking. Coordinates assigned regulatory and compliance activities, including provider attestations, Model of Care training, delegated oversight, accreditation or audit requests and corrective-action follow-up.

Leads defined initiatives or assigned portions of larger projects, maintaining plans, responsibilities, deadlines and decisions and escalating barriers when needed. Maintains complete and timely provider account, contracting, issue and outcome records in designated systems; report risks and complete assigned mitigation actions.

Applies feedback and developing knowledge of managed care, reimbursement and provider performance to take on increasingly complex provider work. Exercises judgment with general supervision for lower-complexity provider work. Resolves day-to-day provider matters and agrees to operational resolutions, implementation plans, education and corrective actions within assigned authority.

Leads straightforward negotiations using approved parameters and escalates nonstandard terms, significant risks and decisions outside delegated authority. Remains accountable for assigned provider relationships through contracting, implementation and ongoing service, including timely follow-through when work depends on other departments.

Participates in special projects and performs other duties as assigned.

Education

Bachelor's Degree in healthcare administration, business, public health, health services, communications, education, psychology or relevant work experience required Work Experience: Ability to evaluate information, communicate clearly, organize work and follow through on commitments required Demonstrates sound judgment, readiness to learn managed care concepts and an understanding of when to seek guidance required Communicates clearly in writing, meetings and presentations.

Uses facts and sound reasoning to explain recommendations and gain cooperation required Works effectively when information is incomplete or priorities change. Handles conflict and difficult conversations professionally required Adjusts work hours occasionally to accommodate provider meetings and business needs required Experience supporting Medicare, Medicaid, dual-eligible, managed long-term care or other government-sponsored healthcare programs, or experience in a provider practice or provider administration environment preferred