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Vendor Relations Manager

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MetroPlus Health PlanNew York, NY
  • $65,000 - $70,000 a year
  • MetroPlus Health Plan provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
  • 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.
  • For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.
  • Vendor Relations Manager: Responsible for implementing, maintaining, and monitoring the relationships with MetroPlus’ contracted High Dollar Review and Special Investigations (SIU) Vendors in order to best meet MetroPlus’ corporate and regulatory goals; Provide management of vendors in accordance with MetroPlus policy and regulatory requirements; Manage various communications, focused projects, and ongoing work efforts and coordinate their completion with MetroPlus departments and Vendors.
  • Be the main point of contact for two vendors: One that is responsible for coordinating investigations into potential fraud and abuse by network providers; and one vendor that is responsible for reviewing medical records to determine if high dollar claims are appropriately billed and coded.
  • Both vendors serve a need for containing plan costs and eliminating unnecessary costs in payment for healthcare services.
  • Analysis of monthly reporting, specifically for High Dollar and Special Investigation Units.
  • Assess any areas where improvement may be needed, or where MetroPlus and the contract goals are not being met.
  • Work with the Manager to implement and follow through with corrective action plans as needed.
  • Set priorities, monitor performance and develop analytical and financial reporting of vendors including routine scorecards and agreed upon KPI’s.
  • Serve as a central point of contact between MetroPlus internal areas and the vendor.
  • Assist in coordination of regulatory responses, audit, claim requests and other MetroPlus needs as required.
  • Address day to day issues related to the Vendors and work with internal partners (Claims, Finance, and Operations etc.)
  • to resolve issues in a timely manner.
  • Perform as go-between for external vendors and internal stakeholders.
  • Identify improvement areas internally as well as perform closely with all internal stakeholders to prepare solutions.
  • Identify cost improvement opportunities and develop and maintain strategies that conform to the management of overall medical costs.
  • Track cost savings from each vendor.
  • Coordinate between MetroPlus internal areas and the vendor to monitor open cases and audit activities to extract files and process as appropriate
  • Identify and implement continuously enhance efficiencies associated with vendor management for SIU and High Dollar vendors.
  • Participate to formulate workflow processes, methods and policies for applying vendors.
  • Stimulate steady process enhancement to present increasing operational efficiency in entire business partner processes.
  • Support to explore expansion across new business lines and products and make recommendations regarding potential opportunities and appropriateness.
  • Support updating applicable processes and procedures.
  • Assist in training to ensure appropriate processes and procedures are communicated and properly followed.
  • Ability to pull reports, scrub and analyze data, and present it in a clear and meaningful manner.
  • Oversee monitoring of vendor performance against contractual obligations to ensure overall effectiveness of vendor provided services with the utilization of vendor performance dashboards, scorecards and/or report
  • Proactively engage with corporate departments to support initiatives and strategies associated with key metrics for the unique partnership and the growth of the partnership.
  • Be able to work with Managed to identify Return on Investment (ROI) for specific vendor relationships and capture the value that each vendor brings to MetroPlus.
  • 3-5 years vendor management experience with at least 2 years of benefit configuration and claims processing and adjudication experience.
  • 1-2 years of managed care experience including Enrollment and Claims processing platforms
  • Bachelor’s Degree in Finance, Accounting, Business, Health Care Management, Information Technology or other similar area, highly preferred.
  • Background or Certification in Healthcare Coding preferred
  • Ability to work independently with minimal supervision
  • Background in provider and facility claims – understanding of health care coding and claims processing.
  • Understanding of health plan payment methodologies and reimbursement for different types of services
  • Competent at relationship-building.
  • Focuses on understanding the needs of the Plan and getting the best possible results
  • An ethic of service, an understanding and anticipation of a Plan’s changing business needs
  • Comfortable working as a team lead and training colleagues as needed
  • Ability to document business processes and create policies which are compliant with CMS requirements
  • The ability to manage stress and conflict, keeping composed and acting as a mediator when conflicts arise
  • Using interpersonal and communication skills to network in an effective way
  • Sensitive to changing personal demands and requirements and changes accordingly
  • Uses his/her time effectively and efficiently
  • Good analytical skills and ability to prioritize diverse responsibilities
  • Proven ability to learn appropriate software
  • Effective problem solving, and analytical skills are required with the ability to evaluate demands on time
  • Problem-solving, including other stakeholders
  • Operations – logistics, processes, integration
  • Communications – explanation, meetings, negotiation
  • Business and financials –analysis, forecasting,
  • Project management – by timelines, milestones and deliverables
  • Business and financials –analysis, forecasting, ROI, savings
  • MetroPlus Health Plan - Today
  • Get job updates from MetroPlus Health Plan
  • Since 1985, MetroPlus Health Plan, Inc., a prepaid health services plan, has been offering low or no-cost quality health insurance to eli
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