Sr Account Manager Provider Complaints
Yesterday• New York, NY
Description and Requirements
The Sr. Account Manager, Provider Complaints is an integral role that successfully manages escalated provider complaints as assigned. Reporting directly to the Sr. Manager, Complaint Resolution, they will be dedicated to (1) expediting the research of formally reported provider complaint (2) contacting providers to negotiate single case agreements and working through the various complaint details and (3) working with the appropriate internal stakeholders to close out all aspects of the complaints. In this role, the Sr. Account Manager, Provider Complaints deals with providers that require one-time resolution as well as serves as a single point of contact for Out of Network providers who have submitted a formal complaint. The Sr. Account Manager will drive results that increase provider satisfaction and reduce/eliminate repeat complaints from assigned providers. Efforts directly impact the improvement of CMS STAR ratings.
Duties & Responsibilities:
- Serve as internal point of contact for cross-functional internal departments and teams to ensure all provider complaints are addressed and resolved within established guidelines
- Partners with Sr. Complaint Analyst, and performs root cause analysis, to ensure effective identification of contributing complaint issues
- Performs all tracking and trending of activity on managing root cause inventory, as well as resolution of all root cause issues identified
- Communicate complaint resolution results to key stakeholders
- Drafts complex complaint summaries and speaking points to ensure Regulatory can effectively respond to external agencies regarding all aspects of a complaint
- Makes recommendations on strategy and process improvement to drive successful outcomes of assigned complaints
- Negotiates complex single case agreements and settlements with complex providers as needed to resolve a complaint
- Works cross functionally to assist with resolution of complex claims related issues
- Tracks all aspects of provider complaints and ensures all assigned deadlines are met
- Serves as a subject matter expert for Delivery System Engagement on resolution of provider complaints
- Additional duties as assigned
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Minimum Qualifications:
- Network Management / Provider Relations experience with Hospital, Physician, Ancillary and/or Behavioral Health providers
- Familiarity with reimbursement methodologies (DRG, FFS, Capitation, APG, APC)
- Experience with resolution of reported provider complaints
- Managed Care operations experience working with various business partners to facilitate resolution (Legal, Regulatory/Compliance, Claims)
- Resolution of root cause contributing to provider complaints
- Work experience with MS Excel, Word, Power Point
- Bachelor's Degree from an accredited institution or equivalent work experience
Preferred Qualifications:
- Cross functional experience in working as a liaison to internal business partners
- MS Visio
- Critical thinking skills
- Great attention to detail
- Master's Degree from an accredited institution
Compliance & Regulatory Responsibilities: Noted above
Hiring Range:
- Greater New York City Area (NY, NJ, CT residents): $103,400 - $149,430
- All Other Locations (within approved locations): $88,700 - $131,920
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.
In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.
The hiring range is defined as the lowest and highest salaries that Healthfirst in "good faith" would pay to a new hire, or for a job promotion, or transfer into this role.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any other legally protected basis. HF Management Services, LLC shall not discriminate against any disabled employee or applicant in regard to any position for which the employee or applicant is otherwise qualified.
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 careers@Healthfirst.org 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 HF Management Services, LLC will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with HF Management Services, LLC.
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Client-provided location(s): New York, NY
Job ID: healthfirst-R021562
Employment Type: OTHER
Posted: 2026-03-06T20:10:33
Perks and Benefits
Health and Wellness
- Health Insurance
- Health Reimbursement Account
- Dental Insurance
- Vision Insurance
- Life Insurance
- Short-Term Disability
- Long-Term Disability
- FSA
- HSA
- Fitness Subsidies
- Mental Health Benefits
- Pet Insurance
Parental Benefits
- Birth Parent or Maternity Leave
- Family Support Resources
Work Flexibility
- Remote Work Opportunities
- Hybrid Work Opportunities
Office Life and Perks
- Commuter Benefits Program
- Casual Dress
- Happy Hours
- Company Outings
- Holiday Events
Vacation and Time Off
- Paid Vacation
- Paid Holidays
- Personal/Sick Days
- Volunteer Time Off
Financial and Retirement
- 401(K) With Company Matching
- Performance Bonus
Professional Development
- Internship Program
- Tuition Reimbursement
- Promote From Within
- Access to Online Courses
- Lunch and Learns
- Associate or Rotational Training Program
- Learning and Development Stipend
- Leadership Training Program
Diversity and Inclusion
- Employee Resource Groups (ERG)
- Woman founded/led
- Diversity, Equity, and Inclusion Program
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