Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Senior Provider Relations Coordinator (Albany)

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Manager & Professional
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1913X Requisition #
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The Provider Relations Senior Coordinator operates as a vital link between Low Touch clinicians for Emblem Health, and its affiliated Plan partners, by establishing effective communication through outbound telephone calls and clinician correspondence to provide information on contract terms and conditions, education on new products or product enhancements, Plan(s) initiatives, policies and procedures and related questions or issues.  The Provider Relations Senior Coordinator is the lead contact for all escalated compliance issues, grievances and disputes and member billing complaints.  In addition, the Provider Relations Senior Coordinator will coordinate and conduct quarterly (frequency varies by locality) Provider Forum meetings to service and educate the Low Touch clinicians on the Plans of GHI, HIP and Emblem Health.  The Senior Coordinator is also responsible for attending convention/conferences and conduct in-person visits upon request.  The Senior Coordinator will support the Lead Coordinator with research of the clinician issues and provide feedback.  All corporate contracting initiatives will be handled by the Provider Relations Senior Coordinator.  The Senior Coordinator completes HEDIS medical record retrieval and other projects as needed.  The majority of functions of this position will be conducted in-house.

Responsibilities:
  • Act in response to all outbound telephone calls and clinician correspondence made by or sent by Low Touch clinicians.  Collaborate with Emblem Health departments to facilitate timely resolution of Low Touch clinician escalated compliance issues, grievances, disputes and member billing complaints.  Take lead on issues referred by Lead Coordinator and when appropriate, escalate to Lead Coordinator to conduct on-site visit and relationship management for Low Touch clinicians.  All contact document in compliance with department standards.
  • Negotiation and retention of clinician(s) including responding to requests to join the Plan(s), recruitment initiatives and request for clinician(s) participation from other department(s) and members.  Work in partnership with Credentialing Department on activities relating to Low Touch clinicians such as the submission of completed applications, site visits, contracts and materials related to credentialing necessary to comply with Plan standards.  All contact documented in compliance with department standards.
  • Maintain a schedule, coordinate and conduct quarterly Provider Forums to service and educate Low Touch clinicians on new products or product enhancements for GHI, GHIHMO, HIP and Emblem Health.  In addition, educate clinicians on Plan(s) initiatives, policies and procedures and related questions or issues.  Attend conventions and conferences to educate clinician community.  All contact documented in compliance with department standards.
  • Perform outreach projects as related to clinicians.  This includes requests by the Plan’s State Sponsored Programs Department for DOH, IPRO and DOI notices.  In addition, performs HEDIS medical record retrieval and other projects as needed.  All outreach documented in compliance with department standards.
Qualifications:
  • A Bachelors degree in Health Care related field, Public Administration, or Management desired
  • Masters Degree a plus
  • Two years of direct provider relations field experience required
  • Knowledge of provider and payor roles, responsibilities and challenges.  An understanding of health care financing, access issues, delivery systems, quality controls, and legislation required
  • Strong customer service skills and the ability to maintain an excellent rapport with providers and their staff required
  • Ability to work well with various Plan departments is instrumental in the effectiveness of the position required
  • Excellent communication skills, written and verbal, to ensure that the appropriate requests are articulated and that problems are accurately represented for resolution required
  • Time management skills and flexibility to work on multiple projects/assignments simultaneously, with ability to change focus in a crisis situation  Willingness to assume diverse duties and challenges required
  • Interpersonal skills to effectively maintain working relationships to get issues resolved or to obtain information through people, and to represent the Plan and the Department in a favorable light required
  • Ability to work independently on field assignments and maximize opportunities to support providers on site.  Willingness to spend majority of time in field, as opposed to office required
  • Analytical and problem solving skills to identify needs in provider relationships, make recommendations as projects develop and follow through to resolution using available resources to achieve a solution required
  • Proficiency testing in Excel, Word and other Microsoft applications required
  • PC skills including proficiency in email, database application a plus; preferred

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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