Serve as a liaison between EmblemHealth and provider community within Richmond/Suffolk county service area.Responsible for recruitment, contracting, database management and Access and Availability auditsInvestigate and respond to inquiries from Grievance and Appeals, Customer Service, Credentialing, Claims and other departments. Conduct provider orientations and educate staff on policies, procedures, product lines and benefits.Handle recruitment of nonparticipating providers including creating specialized fee schedules Handle Single Case Agreement negotiation for non-participating providersIdentify network gaps and complete contracts or work with Network Development

Established strong relationships with Federally Qualified Health Centers (FQHC), hospitals and physicians within the NYC metropolitan area.Assisted Medicaid/Medicare sales team in securing provider leads to increase membership enrollment.Prepared and maintained credentialing file & reviewed applications, site evaluations and contracts. Managed Provider Assessments with emphasis on quality performance and increased profitability.

Served as liaison between HIP and provider community in Westchester/Rockland county service area. Oversaw initial application requests and reviewed Aperture/CAQH applications and HIP agreements for initial credentialing process. Served as the relationship manager between HIP and various delegated entities.Assisted in maintaining provider files involving terminations, service/billing updates, & amendments.