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Amida Care, the largest Medicaid HIV Special Needs Plan in NY, delivers a uniquely effective care model that has become a true benchmark for innovation, engagement and member health outcomes. Our mission is to provide access to comprehensive care and coordinated services that facilitate positive health outcomes and general well-being for our members. This true integrative care model addresses psychosocial, housing, behavioral and medical services directly evolving around the needs of each member.

We are a community of individuals from diverse peoples who work together to actively foster a fair, equitable, inclusive environment where all employees receive an invitation to belong. Visit www.amidacareny.org for more information about the Amida Care culture.

We are actively seeking a highly motivated, innovative and experienced leader to join our team as the Provider Network Representative – Field. Compensation will be commensurate with experience.

Position Summary:

This position develops, contracts, maintains, and enhances relationships with facilities, physicians and ancillary providers within designated geographic area(s) to drive business results. This position is responsible for the appropriate representation of providers relating to contractual arrangements, compliance, regulatory, credentialing, claims, provider files and administrative policy and procedures. This position may be assigned to service sponsors and/or other large provider entities, possibly in multiple boroughs.

Responsibilities:

Successfully execute all processes to support the Provider Directory and other pertinent reports. This includes, but is not limited to, modifications of records to assure appropriate support of business processes and all other activities in a timely manner.
Ensure provider data is entered in systems in alignment with contractual agreement.
Partners with other internal departments, including but not limited to Health Services, Finance, Claims, and Coding in order to develop solutions for strategic business needs.
Conducts limited negotiations and drafts contract amendments.
Conduct regular service visits to ensure provider service needs are met, resolve issues, educate providers and provider staff on policies and the web-portal usage, collect credentialing information, and review Healthcare Effectiveness Data and Information Set (HEDIS) information, etc.
Work closely with key Departments to ensure successful implementation of Provider Agreements from initiation to approval, including provider credentialing applications, environmental site reviews, system configuration, and orientation.
Ability to have intimate knowledge of how provider practices operate and how plan policies may impact or be impacted by this structure and understanding of various reimbursement methodologies and how it relates to cost
Serve as plan liaison for physicians/physician groups in a specified geographical area. Will be main point of contact for all plan-related issues including contracting, billing and reimbursement. Responsibility for the resolution of all issues, including those identified by the provider, and those identified internally that have an impact on the physician.
Implement and/or provide ongoing relationship management for large, high profile physician groups, Independent Practice Associations (IPAs), and hospital systems with positive business results.
May participate in intradepartmental projects or smaller projects impacting multiple departments.
Maintain accurate, up-to-date information regarding key contact, clinical, and other key staff at Provider practices and hospitals.
Provide delegated provider with quarterly roster participating providers and oversee audits for accuracy.
Manage delegated roster submission and assure timely receipt and loading into provider database.
Operates with general supervision, elevating unusual situations to management as required.

Amida Care is Diversity, Equity and Inclusion employer committed to full inclusion and elimination of discrimination in all its forms. We strive to develop, promote and sustain a culture that values equity and leverages diversity and inclusiveness in all that we do.

Amida Care requires that all candidates selected for employment must provide proof of full Covid-19 Vaccination upon acceptance of an offer of employment.

EDUCATION REQUIRED:

Bachelor’s Degree in health care administration, business or an equivalent combination of education and work experience in managed care or health care.

EXPERIENCES AND/OR SKILLS REQUIRED:

Minimum of five years’ experience in health care; including a minimum of three years in provider/ payor contracting.
Extensive experience in developing contract types, fee arrangements and other contract terms and in developing and recommending potential solutions to contract issues.
Proficiency in Microsoft Office software (Word, Access, Excel).
Ability to travel efficiently and continuously to and within assigned geographic area.
Strong organizational and project management skills.
Demonstrate understanding and sensitivity to multi-cultural values, beliefs, and attitudes of both internal and external contacts.
Demonstrate appropriate behaviors in accordance with the organization’s vision, mission, and values.

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