Provider Relations Representative

Metropolitan Jewish Health System
United States, New York, New York
Mar 11, 2025
The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms. The Provider Relations Representative is responsible for managing all aspects of the business relationship with all directly contracted physicians/customers in the field. This individual will ensure that all appropriate resources are available and utilized effectively/efficiently to maximize provider satisfaction and downstream member satisfaction. They will provide the same level of timely and accurate service to internal customers (e.g., other Elderplan departments and MJHS affiliated companies) that rely on work performed by Provider Relations. Key responsibilities: Develops and maintains positive provider/customer relations and coordinates with various functions within the company to ensure provider issues, inquiries and complaints are handled appropriately while balancing provider needs with Plan priorities. Utilizes knowledge of healthcare practice management and/or medical billing process/procedures to maximize provider satisfaction and promote organic growth. Work with management to identify and recruit selected non-hospital providers and negotiate contracts within established parameters. Works with participating providers regarding benefits, policies and procedures, SNP Model of Care and NCQA Structure and Process Measures, and Quality Improvement activities (including HEDIS and Star Ratings). High School Diploma or equivalent combined with 6+ years of experience in Managed Care, Practice Management or large group practice, OR, Bachelor's Degree in related field. Minimum two years of experience in Managed Care, Practice Management or large group practice. Knowledge of Microsoft Office Driver's License with well-functioning car available and accessible for full-time use. Strong communication and presentation skills, both written and verbal, as well as public speaking skills.