Provider Account Liaison - Delaware Medicaid

Highmark Health

2d•Remote

About The Position

We are actively seeking a highly skilled and dedicated Provider Account Liaison to be the primary liaison between Highmark Health Options and our contracted providers within the Delaware Medicaid network. This pivotal role is primarily focused on building and fostering relationships and ensuring providers are thoroughly informed about our policies, procedures, and all crucial information detailed in the provider manual. By proactively educating and engaging our providers, you will be instrumental in preventing issues, fostering compliance, and ultimately enhancing the overall provider experience and quality of care for our members. You will play a critical role in building and fostering strong, collaborative relationships across our provider network, actively contributing to network management, training, monitoring, and enforcement of company policies and procedures, all while increasing provider efficiencies. You will also address and help resolve complex trending claims issues that may arise from a lack of understanding or system challenges. This role is a remote based role. You will need to be a resident of Delaware.

Requirements

Minimum Bachelor's Degree - Business, Healthcare related field
5 - 7 years of experience in the healthcare/insurance industry
In-depth understanding of the provider community (market knowledge) and global understanding of care delivery models and the insurance industry
Knowledge of reimbursement methodologies and models as well as financial and analytical modeling
Public speaking/delivering presentations
Negotiation skills
Process/quality improvement
Strong written and oral communication and organizational/project management skills
Broad knowledge and working experience with various software packages such as Microsoft PowerPoint, Excel, Word
Knowledge of required compliance with Centers of Medicaid and Medicare services (CMS) laws and regulations, policies and guidelines regarding Medicare Advantage and Medicaid plans; HIPAA privacy and security regulations

Nice To Haves

Prior experience in provider relations, healthcare or insurance industry
3 - 5 years of experience in presenting concepts to varying audiences
3 - 5 years of project management experience or other relevant experience with high accountability for managing multiple tasks with defined deadlines

Responsibilities

Assume a leading role in the education and implementation of the provider network and contracting strategies for all assigned providers.
Lead and manage relationship with assigned providers to proactively measure, anticipate and prevent problems as well as continually improve operational efficiencies and achieve corporate objectives around programs and strategic initiatives with providers.
Proactively identify provider issues; recommend solutions and ensure provider receives the necessary support and resources to carry out the solutions.
Coordinate in a matrixed liaison role with operations and support areas to ensure the appropriate development and execution of initiatives, communication needs, and issue resolution.
Lead and manage activities to implement the provider network and contracting strategies for the large/complex provider groups within the region.
Partner with key provider groups to gain buy-in and “sell” strategic initiatives for the purposes of piloting and implementing alternative care/reimbursement models.
Act as a conduit back to project teams for provider input and feedback on strategic initiatives.
Work to gain consensus and incorporate necessary plan modifications.
Assist with contracting as it relates to implementing key provider strategies.
Drive the high level interactions and direction of the Pay for Value (P4V) relationships.
Communicate with the appropriate business leaders on the P4V program participation, opportunity, performance, and progress.
Engage appropriate resources, tools, analytics, and reports to enable success in the programs to drive better health outcomes, lower unit costs, and higher patient satisfaction for our members.
Oversee administration of critical and timely communication to providers through ongoing personal contacts, on-site field visits, regional communication sessions, and meetings with professional organizations to communicate initiatives and changes.
Develop, participate in, and support education to providers due to changing reimbursement environment, product portfolio, processing requirements, and new technology offerings.
Meet with contacts at various levels at key physician practices to ensure appropriate levels of communication and maintain harmonious relationships.
Maintain current market knowledge, industry knowledge and innovation awareness to drive the change needed to transform the way healthcare is delivered and reimbursed.
Collect market intelligence to contribute to strategic planning and design of products and networks.
Other duties as assigned or requested.