Description and Requirements
Duties & Responsibilities:
- Oversee and monitor 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
- Demonstrate self-reliance, independent thinking and decision making in leading vendors or working across various Healthfirst teams
- Maintain effective working relationships with 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)
- Serve as Liaison between vendors and cross-functional internal departments and teams to ensure timely and quality deliverables from vendors and internal departments
- Collaborate with other departments within Healthfirst to improve all aspects of functions including performance metrics, member satisfaction and CMS/ NYS DOH audits
- Leverage vendor scorecards to track and trend KPIs related to contractual penalties or incentives
- Participate in Vendor Performance Committee, Joint Operating Committee and other meetings or 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
- Perform review of NYS DOH, 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 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
- Perform IT user acceptance testing (UAT) assessments related to enrollment files, claims reporting, encounter data files, accumulator files, etc.
- Identify opportunities for process improvement and efficiencies to reevaluate processes and workflows
- Perform other duties as assigned or necessary
Minimum Qualifications:
- 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
- Significant experience managing the vendor relationship of multiple complex vendors
- HS Diploma or GED from an accredited program
Preferred Qualifications:
- Knowledge of health insurance/ healthcare/ managed care environment
- Experience with Relationship/ Account Management
- Effective verbal and written communication skills
- Bachelor's Degree or higher from an accredited institution
Compliance & Regulatory Responsibilities: Noted above
License/Certification: N/A
Hiring Range*:
Greater New York City Area (NY, NJ, CT residents): $81,100 - $117,470
All Other Locations (within approved locations): $71,600 - $106,505
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.