Senior Network Account Manager

HealthFirst

About The Position

The Senior Account Manager is committed to the development and supervision of a high performance provider network, through various provider engagement strategies which follow four core principles: Quality, Clinical Efficiency, Administrative Efficiency, and Population Health. The individual at this level functions as a cultural ambassador and strategy driver for Healthfirst. He/she will embody Healthfirst’s Standards of Excellence through his/her workplace behavior. S/he will also promote and reinforce subordinate behavior that is consistent with Healthfirst’s desired culture and fulfill his/her role in aligning Healthfirst’s strategic initiatives with the desired organizational culture.

Requirements

Medicare and/or Medicaid managed care experience
Provider office operations experience
Ability to understand provider claims reimbursement
Contract negotiation experience
Professional writing skills (Letter writing, Memo and Email)

Nice To Haves

Bachelor’s degree

Responsibilities

Advance Healthfirst through superior customer service focused leadership in an assigned territory and team, which will help to optimize provider satisfaction
Educate and train network representatives in key business principles around profitability, network adequacy, quality, etc.
Promote successful internal collaboration within Healthfirst for our providers: Shared mutual goals by working directly with the hospital and affiliated provider teams to improve their clinical, quality and member satisfaction outcomes
Provide effective education and communication of Healthfirst benefits and policies, changes, and effects to individual practices
Collaborate, develop, and deliver appropriate reports that allow provider partners to better manage their patient population (roster, care plans, quality reports, etc.)
Propose and implement initiatives or process changes with providers that will ultimately encourage process improvements within the healthcare delivery/administrative structure
Provide customer service focused leadership to optimize provider satisfaction through timely and accurate issue resolution
Propose and implement initiatives or process changes with providers that will ultimately encourage process improvements within the healthcare delivery/administrative structure
Manage projects
Provides status of projects as well as ensures completion of projects assigned
Provides coaching/mentoring for staff
Identifies improvement for further training/education
Critical thinking that solves problems with a logical, analytical discipline with a view on how decisions may impact provider/practice operations
Understanding of various reimbursement methodologies as it relates to the community provider network
Strong grounding of core principles and the role of hospitals within both Clinical Efficiency, Population Health, and Administrative Efficiency
Proactively identify trends of issues, root causes and their magnitude, develop and implement action plans to closure
Ability to review and draw conclusions from reports that integrate job knowledge and practical applications that answer or respond to a question or issue or may lead to other issues
Fiscal understanding of reimbursement and utilization practices
Ability to analyze reports related to provider performance and relate provider practice patterns to overall trends
Negotiation skills which clearly allow for ranges of discussions with a clear line of escalation when necessary as well as presentation for approval from Senior Management
Regulatory/ Legal understanding of the contracting logistics
Solid understanding of terms of contracts and how they should be applied: financial, amendment, termination, etc.
Understanding and ability to guide translation of contract terms into system rules, i.e., configuration, creation or amendment of new provider records and knowledgeable review to ensure accuracy of future claims
Ability to guide and facilitate the team’s contracting process from start to finish