About this opportunity
Healthfirst lists this AVP Payment Configuration opportunity in new york, New York. Review the employer’s description below for duties, qualifications and application requirements.
Job description
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.
Responsibilities
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 Provider operational areas: Claims Configuration, Onboarding and Credentialing
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.
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Worksite address
new york, NY, 10261, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.