Ancillary Service Contractor
Ancillary Service Contractor
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$ 59800 - 88910
1 Vacancy
Job Description
- Manage a network of Ancillary Providers for all lines of Healthfirsts business (such as Medicaid CHP Medicare and Commercial). Monitor and audit contracted ancillary providers to ensure that accurate demographic payment and fee schedules are loaded into the HF Provider System correctly. Resolve configuration issues by identifying root causes in order to prevent claims denials and to ensure claims are paid correctly. Facilitate meetings cross departmentally to achieve positive outcomes in management of ancillary provider network.
- Create contracts in HF contract software and review credentialing documents submitted by Provider/facility via Universal Credentialing Data Source The Council for Affordable Quality Healthcare (CAQH) or PDF application to ensure that all the required credentials are included and that valid documents for behavioral Providers and facilities are provided
- Negotiate and execute Single Patient Agreements for Out Of Network (OON) Providers in order to determine the Providers payment arrangement. Individual should be familiar with contracting and reimbursement methodologies for ancillary services providers.
- Educate newly credentialed Providers on Healthfirsts policies and procedures such as billing and authorization requirements utilization of Healthfirsts Provider portal claims submission etc. via various methods (telephonic facetoface webinar etc..
- Analyze provider network based on monthly report to ensure that Plan is meeting Health Plan Network (HPN) State requirements. The individual would work closely with Network Management Credentialing and the business analytics unit within the Ancillary department to complete the analysis.
- Identify root cause of claims issues and facilitate resolution by working closely with Reimbursement and Claims departments. Clearly communicate resolutions and progress to the Providers. Assist Appeals and Grievances (A&G) department by acting as liaison between Providers and A&G department to achieve favorable outcomes of member related issues complaints balance billing and other issues.
- Ensure that all Providers inquiries received via email and phone call are addressed efficiently and effectively within required timeframe.
- Assist management with research and facilitation of projects related to contract updates new product implementation and new reimbursement methodologies.
- Additional duties as assigned
Minimum Qualifications:
- HSD/GED
- Experience managing or performing high level servicing to a portfolio of customers/providers
- Ability to troubleshoot claims issues
- Ability to work independently in dynamic environment Ability to take initiative and work independently
- Ability to prioritize and multitask Strong customercentric and analytical skills Strong sense of urgency and selfmotivational qualities
- Excellent oral and written communication skills
Preferred Qualifications:
- Bachelors Degree
- Contracting experience
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to 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.
If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment please contact us by sending an email to or calling. In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the email address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.
All hiring and recruitment at Healthfirst is transacted with a valid @healthfirst email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst or not one of our recruitment partners please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.
Hiring Range*:
Greater New York City Area (NY NJ CT residents): $67200 $97155
All Other Locations (within approved locations): $59800 $88910
As a candidate for this position your salary and related elements of compensation will be contingent upon your work experience education licenses and certifications and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary Healthfirst offers employees a full range of benefits such as medical dental and vision coverage incentive and recognition programs life insurance and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
*The hiring range is defined as the lowest and highest salaries that Healthfirst in good faith would pay to a new hire or for a job promotion or transfer into this role.
Required Experience:
Contract
Employment Type
Full-Time
