The Manager, Ancillary Services reports directly to the Director, Ancillary Services and is responsible for staff and daily activities of the department. The Manager is responsible for recruiting, contracting and maintaining a network of ancillary providers for all Healthfirst lines of business. The Manager also serves as the key contact for the resolution of ancillary issues as they are identified.
- Oversees and develops ancillary provider recruitment and strategy, as necessary, for regulatory, clinical or customer satisfaction purposes in order for Healthfirst to expand its books of business.
- Contracting and provider service knowledge of various ancillary providers. Understands various contract terms, claims resolution, reimbursement methodologies and quality incentive plans.
- Ensuring that appropriate educational support is provided to Providers that are aligned with corporate guidelines and other initiatives as appropriate.
- Works with Ancillary Contracting staff to help them effectively manage their workload and responsibilities. Works with staff individually to mentor professional development, ensuring that each person understands his/her responsibilities.
- Ensure success and cultivate a positive Provider experience with Healthfirst by developing, supporting, monitoring and mentoring a team of Ancillary Services Contractors that promotes excellent customer service through administrative ease, accurate and timely payments, educational support, clinical support, and aligned goals that share success with Healthfirst strategy.
- Develops and maintains policies and procedures and provides training to team members. Hires, trains, coaches, counsels, and evaluates performance of direct reports.
- Develops reports in conjunction with Provider Operations to monitor and audit system load activities and ensure that accurate information is loaded, including demographic, payment and fee schedule information. Conduct follow|up with internal and external parties to ensure data integrity.
- Represents Ancillary Services at meetings in the absence of the Department Head. Serves as key department contact for escalation of issues from Claims, Medical Management Member Complaints, etc.
- Works closely with Regulatory and Compliance departments to ensure that Ancillary is receiving correct information on issues as it impacts HF and providers. Must be able to understand and work effectively with both areas to address issues and changes in regulations and compliance policies.
- HSD or GED
- Experience should include ancillary contracting and/or managed long term care. - Experience should include strong understanding and ability to guide translation of contract terms and knowledgeable review to ensure accuracy of future claims.
- Should have knowledge of Medicare and Medicaid programs.
- Regulatory and Legal understanding of the contracting logistics.
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 [email protected] 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.
EEO Law Poster and Supplement