Senior Account Manager for Provider Groups

UnitedHealth Group • Kansas City, MO

133d • $71,200 - $127,200 • Remote

About The Position

The Senior Account Manager has geographic responsibility for the quality and economic performance of the physician practice with the goal of developing a high performing provider network within the State of Kansas and Missouri. This includes analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning. The Senior Account Manager will develop and sustain a solid day-to-day relationship with stakeholders, the physician and office staff to effectively implement the business solutions developed by the Client Services leadership team. They are accountable for overall performance and profitability for their assigned groups as well as ownership and oversight to provide redirection as appropriate and approved. The responsibilities of this position include capabilities in the following areas: strategic planning and analysis; understanding of HEDIS, Star ratings, accurate documentation and coding; highly developed communication skills; and the ability to develop clear action plans and drive process.

Requirements

• 3+ years of experience in a related medical field or health plan setting (network management, contracting and/or recruitment, or provider relations)
• Knowledge of state and federal laws relating to Medicare
• Solid working knowledge of Medicare health care operations including HEDIS, CMS reimbursement models, and Medicare Advantage
• Understanding of IPAs, Clinically Integrated Networks, Medicare Savings Programs, capitation/value-based contracting, and narrow networks
• Proficiency in Microsoft Word, Excel and PowerPoint
• Willing or ability to travel 25% of the time

Nice To Haves

• Demonstrated ability to act as a mentor to others
• Demonstrated ability to communicate and facilitate strategic meetings with groups of all sizes
• Demonstrated ability to work independently, use good judgment and decision-making process
• Demonstrated ability to adopt quickly to change in an ever-changing environment
• Proven solid business acumen, analytical, critical thinking and persuasion skills

Responsibilities

• Educate providers to ensure they have the tools needed to meet quality, coding and documentation, and total medical cost goals per business development plans
• Develop strategies and create action plans that align provider pools and groups with company initiatives, goals, quality outcomes, program incentives, and patient care best practices
• Drive processes and improvement initiatives that directly impact revenue, HEDIS/STAR measures and quality metrics, coding and documentation process and educational improvements
• Conduct new provider orientations and ongoing education to provider and their staff on healthcare delivery products, health plan partnerships, processes, and tools
• Use and analyze data to identify trends, patterns and opportunities for the business and clients, and collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues
• Conduct provider meetings to share and discuss reporting data and analysis, issue resolution needs, implement escalation processes for discrepancies, and handles or ensures appropriate scheduling, agenda, and materials
• Collaborates with internal clinical services teams, alongside operational leaders, to monitor utilization trends to assist with developing strategic plans to improve performance
• Assists provider groups with investigating standard and non-standard requests and problems, to include claims and member support services
• Maintains effective support services by working effectively with the medical director, operations, and cross functional teams, and other departments
• Demonstrate understanding of providers' business goals and strategies in order to facilitate the analysis and resolution of their issues
• Performs all other related duties as assigned

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities