Health First
Vendor Relationship Manager
Health First, Kissimmee, Florida, United States, 34747
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
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, 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.
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
WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, 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.