Account Representative

Description

Responsibilities

• Support Manager in managing provider service model for assigned accounts to include: groups, Independent Practice Associations (IPA’s), faculty practice groups, at the 1199SEIU Benefit and Pension Funds
• Monitor and assure contract compliance in areas including, but not limited to: terms of agreement for participating healthcare providers, reporting obligations, member and provider grievances, timely submission and payment of claims, provider credentialing and re-credentialing
• Assist in designing provider-training programs to support organizational goals; arrange orientations and ongoing education for assigned accounts
• Schedule and facilitate regular Joint Operating Committee (JOC) meetings either telephonically or in person on a regular basis to ensure all relevant issues are discussed and resolved (i.e. contracting, claims, administrative issues); to promote positive relationships between the Providers and our Funds
• Provide assistance with the in implementation and management of key healthcare providers, and group contracts; assist with out of network negotiations and fees for contracts
• Conduct on-site visits for key assigned accounts; address and resolve claim issues and provider concerns; explain inquiries related to benefits
• Review existing policies to ensure maximum compliance, troubleshoot issues raised by providers and distribute any needed materials; identify non-compliant providers, and providers with member complaints
• Educate providers regarding new and existing policies and procedures, including but not limited to Medical Management Review programs, claims payment policies, clinical coding policies via written and oral communication
• Perform additional duties and projects as assigned by management

Qualifications

• Bachelor’s degree in Healthcare or equivalent years of experience required;
• Minimum three (3) years’ experience with provider credentialing, contracting or network development in a health insurance or benefits environment required
• Experience educating health care providers, establishing contractual agreements, coordinating and conducting provider recruitment preferred
• Experience in project management, contracting and analysis preferred
• Intermediate knowledge of Microsoft Excel, Word, and Outlook preferred
• Superb communications skills both written and verbal; demonstrated ability to interact and communicate well with individuals to build positive relationships
• Ability to work under pressure with minimal supervision, multi-task, complete projects in a timely fashion and meet deadlines a must
• Available to travel occasionally in the metro New York area as needed

We offer extraordinary benefits including outstanding health, dental, pension and family benefits for most positions which are paid entirely by the Funds without co-payments, deductibles, or out-of-pocket expenses for covered services. We also offer tuition reimbursement, generous holiday, vacation, and sick leave, as well as a 401K plan.