Jimmy Ha Email and Phone Number

• Manage all types of providers in Queens, Manhattan, and Sunset Park in Brooklyn.• Manage large IPA’s and Physician Groups in assigned territory.• Collaborate with Business Development to grow membership in assigned territory.• Increase membership through contracting with non –par providers or Single-case agreements.• Assist Ancillary provider with Claims Inquiry.• Assist with all claims discrepancies with PCP and specialist.• Assist other dept. with resolutions to meet time goals.• Assist with Company project initiatives and ensuring deadlines are met.• Assist with credentialing of providers with site visits, attaining outdated credentials, status reports.

-Manage large IPAs and physician groups-Oversee high volume Centerlight Medical Practices-Ensure assigned Provider Relations Rep. educate providers and their staff on Centerlight Healthcare's benefits, policies and procedures-Collaborate with Clinical Operations and Medical Practices obtaining highly confidential members' Care Plans-Ensure contracted PCP adhere to all PACE regulations-Supervise Provider Orientations for all applicable product lines and onsite provider education-Strategize for membership growth and retention in conjunction with Membership Development to conduct marketing initiatives as well as foster professional relations between marketing staff and network providers to achieve Centerlight's membership growth goals.-Coordinate network development in areas of network expansion-Analyze assigned network for network gaps and adequacy.-Identification and recruitment of providers to fill network gaps or needs-Ensure new provider orientation for all applicable product lines are conducted in a timely manner-Support Provider Relations Representatives in conducting site visits, collects credentialing information and collaborate with department credentialing staff as necessary to ensure that appropriate contracts are executed and implemented-Participate in problem resolution with internal and external providers-Identify and monitor provider issues and concerns. Recommend solutions and follow up with providers during the process as well as communicate resolution to ensure problems have been resolved