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Job Description
- Req#: 548730
- 3 years managed care experience with commercial, Medicare and Medicaid lines of business and regulatory requirements
- Associates degree or two (2) years of equivalent experience required.
- 1-3 years contract management experience preferred
- Negotiation experience preferred
- Demonstrated proficiency in Word, Excel, and PowerPoint
- Understanding of legal and regulatory contract compliance and network adequacy requirements
- Strong planning and workflow management skills with ability to shift priorities to meet day-to-day operational needs
- Demonstrated ability to work successfully with a wide range of internal and external customers at all levels of authority
- Understanding of claims and claims payments
Grounded by a compelling mission, core values, and compassion for people, CDPHP and its family of companies offer a strong foundation for a rewarding career. Established in 1984, CDPHP is a physician-founded, member-focused, and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people, quality, innovation, and community, and its corporate culture supports those values wholeheartedly. CDPHP is committed to fostering a culture of belonging and takes a wholistic approach to diversity, equity, and inclusion. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience.
The Network Optimization Coordinator completes all NYS, federal and regulatory HNS filings, analyzes regulatory changes and the impact on HNS and coordinates all necessary actions. The Coordinator assists with compilation and responses to audits and RFPs. The Coordinator negotiates single case agreements for authorized medical services with non-participating providers. Network Operations Coordinators manage contractual arrangements and performance targets with network vendors. This role may be responsible for maintaining and/or negotiating additional contracts, as assigned
Qualifications:
CDPHP salary ranges are designed to be competitive with room for professional and financial growth. Individual compensation is based on several factors unique to each candidate, such as work experience, qualifications, and skills. In addition to cash compensation, CDPHP employees may be eligible for an incentive payment, a discretionary cash reward based on employee and company performance. Some roles may also be eligible for overtime pay.
CDPHP compensation packages go far beyond just salary. The company offers a comprehensive total rewards package that includes award-winning health care coverage, health care dollars, a generous paid time off allowance, employee assistance programs, flexible work environment, and much more. Learn about all CDPHP employee benefits at https://www.cdphp.com/about-us/jobs/benefits .
As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices on the basis of race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, all qualified applicants will receive consideration for employment without regard to any such protected status.
CDPHP and its family of companies include subsidiaries Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRx Services, LLC.
About the company
An award-winning, not-for-profit, physician-founded and guided health plan based in Albany, NY.
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