Network Account Manager - Hudson Valley

The Network Account Manager represents and advances Healthfirst interests in the Provider market as the preferred and ultimately preeminent plan through superior customer service and execution of Provider engagement strategies. The Network Account Manager represents commitment to developing and managing a high performance network and to engaging in various Provider engagement strategies that follow four core principles: Quality, Clinical Efficiency, Administrative Efficiency and Population Health.

  • 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 marketing, enrollment, 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. Coordinates with all Healthfirst staff to assist as appropriate, including creating project plans, issue logs, conference calls, etc.
  • Responsibility for the provider recruitment process. Identify gaps, complete paperwork, etc.
  • Schedule frequent and regular face|to|face contact with the practice locations to identify any issues and ensure plan visibility.
  • Keep abreast of competitor activity, including new reimbursement and marketing strategies. Negotiate favorable/competitive rates with providers based on market trends.
  • Conduct new provider orientation and identify on an ongoing basis opportunities for education on both clinical and administrative topics. Includes experts in the field of education as needed from in|house staff.
  • Responsible for monitoring and reporting on providers' clinical quality & financial performance, working with their manager and other internal departments to create strategic improvement plans.
  • Working under light supervision, maneuvers multiple tasks independently with a fast|paced proactive vs. reactive approach to changing priorities while meeting departmental objectives. Attention to managing many details and remaining focused in an environment with distractions.
  • Contribute creative solutions and ownership of daily assignments for seamless communication and systematic completion of routine and special projects. Follow protocols and use common sense to escalate situations to management appropriately.
  • Handle other duties as assigned with the occasional need to work weekends, overtime and/or travel throughout the tri|state area. Engage in mastering the Division's impact on Healthfirst, its Members and Providers

Minimum Qualifications:

  • Medicare and/or Medicaid managed care experience
  • Experience with MHS, Macess, and/or electronic archiving
  • Provider office operations experience
  • Ability to understand Provider claims reimbursement
  • Contract negotiation experience
  • Professional Writing skills (Letter writing, Memo and Email)
  • Excellent oral and written communication skills

Preferred Qualifications:

  • Bachelor's degree
  • Bilingual fluency (reading, writing, speaking) Spanish and English

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status 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 212-519-1798 . 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 e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

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