Reporting to the Director, Delegated Vendors, the Manager, Ancillary Delegated Vendors will lead the oversight responsibilities of their vendor delegated functions. This position will serve as a liaison between the vendor and Healthfirst. They will support the vendor management processes and programs at Healthfirst to ensure that contractual and regulatory requirements are met.
- Oversee and monitor delegated vendor and internal business owner relationships to ensure compliance, optimal delegate performance and achievement of business goals according to Service Level Standards and other contractual requirements.
- Resolving all issues related to ancillary delegated relationships.
- Serve as Liaison between vendors and cross-functional internal departments and teams to ensure timely and quality deliverables from vendors and internal departments such as Network, Claims, IT/IS, Medical Management, Credentialing and other areas as needed.
- Acts as a liaison between other departments and delegates related to CMS/NYSDOH audits, member complaints, etc. Collaborates with other departments within Healthfirst to improve all aspects of a delegated functions including member satisfaction
- Responsible for contract negotiations and renewals
- Track and trend Performance Guarantee and key performance indicator related to contractual penalties or incentives
- Provide Director with performance data on vendors based on contractual requirements and Service Level Standards on a monthly/quarterly basis.
- Maintain effective working relationships with delegated vendors and internal business stakeholders to ensure performance metrics are met, identify opportunities for improvement, mitigate risk and eliminate barriers to correct Corrective Action Plans (CAPs).
- Participate in Vendor Oversight Committee, Joint Operating Committees and other ad hoc meetings/activities as directed.
- Analyze, track and follow-up on the timely resolution of errors and issues that are a result of vendor processes; and as necessary escalate unresolved inquiries/complaints to Manager.
- Maintain and update an Issue Tracking Log for delegated vendors.
- Perform review of SDOH, CMS and other internal/external audit templates to validate data
- Serve as a project coordinator to lead projects/vendor configurations as assigned, develop project plans, support workgroup and monitor vendor and internal deliverables
- Assist and lead implementation strategies to improve delegated vendor engagement strategies for HEDIS and STARS Quality Initiatives.
- Participate in Request for Proposal (RFP) process from initiation, contracting and onboarding for potential new delegates
- Analyze, update, and modify procedures and processes to continually improve operations.
- Monitor and report instances of vendor Corrective Action Plans (CAPs) implement CAPs as necessary.
- Perform IT User acceptance testing (UAT) assessments related to enrollment files, claims reporting, encounter data files, accumulator files and as needed reviews for IT changes which impact the delegate
- Monitor electronic feeds and User acceptance testing (UAT) to ensure receipt/transmit data files to delegates
- Identify opportunities for process improvement and efficiencies to reevaluate processes and workflows
- Perform any other duties as may be assigned.
- Demonstrated strong organizational, analytical and interpersonal skills with detail-oriented focus.
- Demonstrated computer proficiency, including but not limited to, Microsoft Outlook and Microsoft Office Word and Excel
- MS Excel proficiency with the ability to create formulas, v-lookups, pivot tables and analyze data
- Demonstrated ability at Planning, Organizing and Executing
- Demonstrated professionalism and leadership skills along with ability to develop and direct projects
- HS Diploma or GED from an accredited program
- Knowledge of health insurance/health care/managed care environment preferred.
- Experience with MS Project, Visio and Adobe Professional
- Time Management, Critical/Creative Thinking and Problem Solving skills.
- Should be adaptable, flexible while working in a fast-paced environment
- Experience with Relationship/Account Management
- Utilizing effective verbal and written communication skills are essential
- Bachelor's Degree or higher from an accredited institution
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.
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