The Hospital Specialist will report to the Hospital Account Director, and will be responsible for planning, implementing and managing all operational and contractual business objectives for both internal and external stakeholders. Focusing primarily on strengthening hospital engagement, improving workflows, being a liaison for improvements on quality program initiatives, partnering with sales/marketing and working with Account Directors in an effort to improve hospital performance and awareness of the Healthfirst business model. This individual shall serve as a trusted partner between Healthfirst and participating hospitals and hospital affiliated providers ("Hospital Providers"), as assigned.

　　The Hospital Specialist will represent and advance Healthfirst interests in the hospital provider market as the preferred and ultimately pre-eminent plan through enhanced customer service and exemplary execution of provider engagement strategies. Responsibilities include: managing day to day operational issues and concerns from hospital partners including but not limited to roster maintenance, claim issue root cause analysis, education/training regarding company-wide initiatives, new product implementation, regulatory initiatives, and other various health plan business objectives; serving as an advocate for Hospital Providers within Healthfirst. Furthermore this individual will offer project management support to other members of the team as we collectively strive to improve the financial and quality performance of our business partners.

　　Act as a valued point of contact for the Hospital Providers. This primarily includes addressing claims and operational issues in a timely manner; identifying proactive ways to improve processes and ensuring a mutually beneficial relationship; having a thorough understanding of each Hospital Provider's contract, physician network, business goals and issues as they relate to Healthfirst; meeting regularly with Hospital Providers; conducting business presentations; etc. Superior customer service and account management will ensure Hospital Provider issues and needs are responded to in a timely and accurate fashion.

　　Ensure that claims issues are addressed timely and accurately. Conduct root cause analysis of any large claims projects submitted. Identify and address provider set|up issues that lead to claims problems. Work proactively with Hospital Providers and other functional departments to identify opportunities for process improvement to reduce the volume of claims projects and other improvements in the healthcare delivery/administrative structure.

　　Work closely with Clinical Quality team and Hospital Providers to improve clinical, quality and member satisfaction outcomes. Ensure appropriate reports are available that allow Hospital Providers to better manage their patient population (e.g. rosters, care plans, quality reports, etc.). Ensure that hospitals are submitting appropriate provider data, including but not limited to demographic information.. Work with Hospital Providers to address Access and Availability issues and assist with corrective action plans, if applicable.

　　Interpret contract language and reimbursement structures and create and maintain contract summaries for assigned hospitals. Ensure contract terms are operationally sound and implemented accurately. Effectively educate and communicate Healthfirst benefits and policies

　　Additional duties as assigned.

　　WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability 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 (http://www.dol.gov/agencies/ofccp/posters)

　　All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst. Healthfirst will never ask you for money during the recruitment or onboarding process.

　　Hiring Range*:

　　Greater New York City Area (NY, NJ, CT residents): $57,400 - $78,030

　　All Other Locations (within approved locations): $49,800 - $74,120

　　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.