About the role
Description and Requirements
The Assistant Vice President (AVP) of Provider Payment partners with senior leadership to design and implement the methods and procedures essential for successful claim & benefit configuration, provider onboarding, and maintenance of provider records. The incumbent provides strategic leadership and oversight to establish strategic plans and objectives that enable accurate, timely, and quality claims and provider payment practices. The incumbent ensures business outcomes are consistent with Healthfirst's values, policies, and procedures as well as compliance with relevant federal and state laws/regulations.
This position requires three days per week in office (Tues/Wed/Thurs) at 100 Church Street, NYC
Implement and maintain the configuration of reimbursement rates and pricing methodologies needed to support contract terms with providers including contracted and out of network providers
Ensure configurations accurately match fee schedules and negotiated rates match contracts so that claims are priced accurately
Implement configuration of benefits to meet the needs of Product, Clinical, Medical Cost Management, and Regulatory requirements
Ensure the quality of the configuration to meet outcomes aligned with the stakeholder requirements
Ensure intake of provider contract related requests including gathering of all contract terms, contract creation, provider demographics & documentation required to validate a provider's eligibility and credentials for the purpose of providing care to our members
Ensure proper set-up and maintenance of our Provider Database across Healthfirst systems including but not limited to new provider loading as well as changes and/or terminations of existing provider records thereafter
Ensure appropriate systems testing, procedure/control development, and ongoing improvement
Ensure all NY state and federal compliance, audit and regulatory requirements are met
Oversee credentialing workflow and policies to ensure they are compliant and support timely loading of provider records
Evaluate, develop, and recommend strategic plans to ensure modern and efficient Provider Payment experience
Build, manage, develop, and continuously improve the Provider Payment experience to meet the diverse and dynamic needs of a growing, evolving organization
Develop an effective team through hiring, training, coaching, and providing ongoing and constructive feedback
Additional duties as assigned
Minimum Qualifications
Bachelor's Degree from an accredited institution or equivalent work experience
HS Diploma or GED from accredited institution
Experience managing others in positions of increasing responsibility environment
Prior experience within Health Insurance Operations
Experience setting departmental strategy, communicating, and influencing impact and progress to senior leadership
Experience with Medicare/Medicaid and Commercial Healthcare
Experience thinking strategically and critically in developing solutions to complex problems
Experience communicating to cross-functional groups within an organization
Preferred Qualifications
Experience in the operations and management of large-scale operational team(s)
Prior experience within technical knowledge in one or more of the Claims Configuration, Benefits Configuration, Reimbursement and Regulatory
Excellent communication skills (verbal/written)
Change leadership skills coupled with exceptional relationship building and influencing ability
Ability to problem solve and approach issues strategically
Compliance & Regulatory Responsibilities: Noted above
License/Certification: N/A
Hiring Range
Greater New York City Area (NY, NJ, CT residents): $168,900 - $258,400
All Other Locations (within approved locations): $168,900 - $258,400
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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