Advanced Search


Start New Search:

nyc health hospitals
fidelis care
provider relations
provider network
claims processing
managed care
public health
healthcare services
primary care
subject matter expert

Director of Provider Relations Hybrid Role

Share Job
Suggest Revision
RCM Health CareNew York, NY
  • Director of Provider Relations Hybrid role (Working Remotely, in the Manhattan Office, and Field)
  • For more than 30 years, this health plan has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
  • They provide the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a comprehensive list of products.
  • The Director of Provider Relations is responsible for the management and oversight of the provider relations team, including but not limited, to the management of goals and metrics, departmental and cross functional processes as well as ongoing improvement activities.
  • This position develops, implements, and oversees strategies and policies and procedures for building collaborative relationships with providers through provider education, training, regulatory compliance and resolving operational issues.
  • Act as a key resource to external providers and internal key stakeholders as it pertains to operational issues impacting provider satisfaction.
  • Improve the provider experience, in coordination with providers and with the plan through focused education and training, performance reporting, effective communication of new products, benefits, policies or initiatives, and resolution of provider issues across the business.
  • Lead joint quarterly and monthly meetings to review progress and performance opportunities with leadership
  • Ensure timely responses to regulatory agencies (i.e., NYSDOH, Client) in response to all Provider Network regulatory and compliance issues.
  • Develop guidelines and measures for provider relations that align with corporate goals and measures.
  • Review and identify trends on call volume received across all provider segments as well as any complaints received; leverage data to implement strategies to further enhance provider plan experience.
  • Responsible for developing and updating trend reporting/dashboards/issues trackers.
  • Create strategies to improve key performance indicators; analyze performance data and identify opportunities and performance drivers.
  • Work cross organizationally to ensure successful implementation of provider performance programs and agreements.
  • Ensure data integrity of provider directory, web search, etc.
  • Develops processes to educate new and existing providers regarding their contractual responsibilities as well as policies and procedures.
  • Monitor provider concerns, collaborate and consult with internal leaders and department to improve operations and resolve issues impacting provider satisfaction and payment.
  • Participates in cross-functional workgroups to understand impact of plan changes and initiatives on provider network, advocating for providers as appropriate.
  • Working collaboratively with Account Management Team, build strong partnership with provider community by cultivating open communication and ensuring Account Leads are aware of provider pain points relative to claims disputes.
  • Facilitate with marketing and retention department management to identify opportunities in current provider locations and cultivate them in viable prospects to increase enrollment and retention efforts.
  • Develops policies and procedures, process improvement initiatives.
  • Direct and mentor staff to ensure job functions are completed appropriately and according to priorities.
  • Coach team members in the use of data and appropriate analytical tools that support improved quality.
  • Support team members in the identification and creative problem resolution for improved processes and expanded use of technology.
  • Ensures department staff remains current in all aspects of Federal and State rules, regulations, policies, and procedures and creates or modifies departmental policies to reflect changes.
  • Systematically keeps staff informed of policy and procedural changes affecting program and administrative operations.
  • Responsible for department staffing decisions and providers supervision to assigned staff, writes, and performs annual reviews and monitors performance issues as they arise.
  • Responsible for hiring and training process including recommendations regarding staff retention, termination, and succession planning.
  • Coordinates department's efforts with those of other departments.
  • Bachelor's degree, preferably in health care administration, and a minimum of 5-7 years' experience in a managed care government program claims processing/analyzing experience, working with facilities in addressing reimbursement issues
  • Master's degree in Health Administration preferred
  • Knowledge of principles of business and personnel administration, management functions and support service functions and ability to direct and supervise personnel
  • Proficient with Windows-based PC systems and Microsoft Office, Sharepoint
  • Energetic, goal driven leader with who can motivate and mobilize staff to achieve goals.
  • A strategic thinker who can assess implications and formulate plans of action
  • Strong problem-solving capabilities
  • Ability to streamline and improve operational processes and metrics
  • Ability to display a high degree of professionalism, initiative, and excellent judgement in making decisions regarding contractual issues and dealing with politically sensitive situations.
  • Strong relationship building skills to influence and work collaboratively with physicians, hospitals, business leaders and internal departments.
  • Proven ability to balance execution of the strategic vision through leadership and delegation with a willingness to dive into the details as required
  • Demonstrated interpersonal skills (including oral and written) to interact effectively with a diverse range of internal and external constituents, stakeholders, and audiences.
  • A high level of diplomacy to anticipate, recognize and address effectively with politically sensitive issues.
  • Willingness to challenge the status quo and implement creative solutions to inefficient processes.
  • Ability to manage multiple projects simultaneously
  • Drive for Customer Success
  • Build Relationships & Cultivate Networks
  • Highly organized, detail oriented, dependable and professional individual
  • Ability to travel to meet with Providers and their representatives
  • Salary up to $160,000
  • with excellent benefits (including pension plan)

Similar jobs:

  • All Jobs
  • Active
Director of Provider Relations - Hybrid Role
RCM Healthcare ServicesNew York, NY
Ensure timely responses to regulatory agencies (i.e., NYSDOH, DFS) in response to all Provider Network regulatory and compliance issues.
$160,000 a year
Director of Provider Relations
MetroPlus Health PlanNew York, NY
As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus Health ’s network includes over 27,000 primary care providers, specialists and participating clinics.
Director of Provider Relations
MetroPlusNew York, NY
As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth s network includes over 27,000 primary care providers, specialists and participating clinics.
Provider Relations Specialist II (Bronx County)
Centene CorporationRego Park, NY
For Fidelis Care only: Must have valid driver license, personal vehicle and ability to travel.
Provider Relations Representative
Midatlantic Employers' AssociationLyndhurst, NJ
The Provider Relations Representative is responsible for the full range of provider relations and service interactions with the health plan, including working with end to end provider issues, use of provider portal, negotiation and contracting efforts, service enhancements and development of engagement programs.
How do Good Interviewers Prepare for Interviews?

Just like candidates take the time to research you and your company, you should take the time to prepare for the interview. Preparing for the interview doesn't just reflect well on your employer brand and create a better candidate experience. Preparation also helps prevent bad hiring decisions. Bad hiring decisions are usually a result of poor execution during the hiring process. However, going into an interview fully prepared and ready to evaluate candidates will help avoid bad hires. So, here are 6 interview preparation tips for employers.

Senior Director of Provider Network Operations
Metroplus Health Plan IncNew York, NY
As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlus' network includes over 27,000 primary care providers, specialists and participating clinics.
Provider Relations Specialist II
Fidelis CareNew York, NY
5+ years of sales, provider relations, or contracting experience.
Provider Relations Representative (Health Insurance)
Midatlantic EmployerLyndhurst, NJ
The Provider Relations Representative is responsible for the full range of provider relations and service interactions with the health plan, including working end to end provider issues, use of provider portal, negotiation and contracting efforts, service enhancements and development of engagement programs.
Provider Relations Representative
ArchcareNew York, NY
The Provider Relations Representative will be responsible for providing support in the recruitment, implementation and servicing of individually contracted providers and vendors.
Why College Students Should Work While in College?

College is a special part of our lives. It’s a time when we prepare for our dream job while creating some of the most memorable moments in life. That said, college life can also be stressful. Not only do we have to spend long hours studying, writing and researching, but we also have to deal with increased tuition fees and living expenses.

Sr. Provider Advocate (Remote)
HealthfirstNew York, NY
Experience in a claims processing, issue resolution, and/or Provider Relations role
Associate Director of Donor Relations
Research Foundation CUNYNew York, NY
Job Description General Description Queens College's Office of Institutional Advancement is seeking a dynamic Associate Director of Donor Relations to coordinate, monitor, evaluate and enhance the stewardship program within the Office of Institutional Advancement.
Remote Provider Relations Representative
LaSalle Networknew york city, NY
If you are interested in growing your career while working from home and qualify for this Remote Provider Relations Representative role, please apply today!
Bilingual (English / Mandarin) Medicare Membership Retention Specialist (HYBRID REMOTE) Flushing
HumanaCorona, NY
The Medicare Membership Retention Specialist will be responsible for the Healthcare Insurance market in their the assigned territory covering Flushing, Queens, NYC. You will focus on by providing local proactive customer service as it relates to member's plan i.e. benefits, enrollment, eligibility, billing issues, payments, provider questions.
When to Tell Your Boss You're Job Searching

The Bureau of Labor Statistics has found that individuals, on average, have 12.4 jobs throughout their working life. So regardless of where you are on the career ladder, it’s inevitable that at some point, you’ll begin looking for another job. That said, you might be wondering

Provider Relations & Enrollment Specialist
PM Pediatrics Management GroupNew York, NY
DescriptionThe Provider Relations Representative will be responsible for:The Provider Relations Representative takes responsibility for building and cultivating a relationship with users and ensures a high level of customer serviceAssist with Provider Enrollment activitiesAssisting with ongoing provider claim denials on payor participating providers.
Remote / Hybrid NP Position Brooklyn Bronx Manhattan Long Island Queens
JobotNew York, NY
Associated topics: arnp c, assistant cna, board, certified nursing assistant, clinic, family, family medicine, family nurse practioner, gyn, nursing assistant cna

Latest Blog Posts: to Prepare to Be Fired - What You Need to DoIf you’re reading this, let me be the first to tell you how sorry I am. Getting fired feels crappy, disheartening, hurtful, and all the other bad, sad words. But here’s what I want you to do. First, let yourself fumble for a minute. Then, pick your head up — sometimes getting fired is a blessing in disguise. If you think termination is around the corner, we’ll teach you how to prepare to be fired and what to do next so you land somewhere even better. to Find a Job That Makes You Happy - 11 Concerning FactsDo you ever feel like your life is like one of those rom-com movie scene openers? You know, the ones where the main character rolls out of bed, awakened by a casually upbeat theme song, sulks their way to the coffee pot, and then trudges toward their computer to begin yet another boring day at work? to Decline a Job Offer You Already AcceptedWhen you think about it, turning down a job offer is not the worst position you could be in. If you’ve been lucky enough to consider multiple job offers, well, then you’re lucky enough. Common Mistakes to Avoid When Employer BrandingCurrently, job searchers are putting extra effort into researching employers. The information they find plays a major role in whether they will pursue an opportunity with you or look for jobs elsewhere. That is why it is now more important than ever to be proactive and intentional when showcasing your workforce and workplace culture. Having a well crafted employer branding strategy can help you strategize and influence your potential candidates so they see your business in the best light. But in order to do that, you should be aware of some of the most common mistakes that employers make. to Say When Terminating an EmployeeTerminating an employee is an inevitable part of doing business. Whether you’re re-structuring your department or you’ve identified a few employees who’re not living up to your expectations, letting people go is necessary for keeping your workforce healthy and thriving. to Utilize Keywords for Your Job AdsBefore we give you the scoop on how to utilize keywords in job ads, it would be helpful if we defined what keywords are and why they are important. In simple terms, to Describe Your Personality with ExamplesImagine you’re in an elevator with the CEO of your dream company and you get to talking. The conversation is going well and you start to imagine yourself working for their company when the CEO turns around and asks you “tell me a bit about yourself.” Would this catch you off guard or would you be able to give a clear and succinct description of who you are?