Provider Account Manager - Strategic Accounts (Eastern PA)

Company :

Highmark Health

Job Description : 

JOB SUMMARY

This job is the primary liaison between strategically aligned provider groups in the Highmark Network.  The incumbent will be responsible for cultivating relationships with these large, complex provider groups and entities, including ancillary provider networks, independent physician organizations and health systems/integrated delivery networks, to ensure success in value-based programs (VBR). This job will maintain visibility in the provider community by representing the organization at various provider functions, meetings, and collaboratives. This job will play an active role in training, monitoring and enforcement of company policies and procedures while increasing provider efficiencies and maximizing quality (STAR/HEDIS).  The incumbent may participate as a regional representative on key operational /product/medical management/reimbursement projects/initiatives that impact providers.  The incumbent will recruit and introduce the value-based programs to the physician network; and work collaboratively with the providers that contract into the programs to reinforce and improve quality, to enrich the patient experience and to reduce the overall cost of care for members.  This job interacts with matrixed areas of the organization, the market facing provider teams and external provider partners. The incumbent will function as a liaison with the providers and internal areas to support and manage the execution of the VBR programs for the organization.  To be successful, the incumbent builds relationships with and work across many departments in the Health Plan.  

ESSENTIAL RESPONSIBILITIES

Value-Based Reimbursement Support 

• Assume a leading role in the VBR activities, education, and implementation of new tools for all assigned providers.  
• Drive high-level interactions and support the value-based programs. Communicate with the appropriate business leaders on the VBR 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. 
• Responsible for educating providers on initiatives focused on managing medical expenses and maximizing HEDIS and STAR metrics in collaboration with internal resources.

​ 

General Provider Support

• 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. Educate providers on changes to reimbursement policies, processing requirements, and new technology offerings. Meet with contacts at various levels at key providers to ensure appropriate levels of communication and maintain harmonious relationships. 
• 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; recommends solutions and ensures provider communicates the necessary support and resources to carry out solutions. 
• Ensure critical and timely communication to providers through on-going personal contacts, on-site field visits, regional communication sessions, and meetings with professional organizations to communicate initiatives and changes.  

Internal Partnership

• Coordinate in a matrixed liaison role with contracting, operations, and support areas to ensure the appropriate development and execution of initiatives, communication needs, and issue resolution. Triage and addresses issues raised by providers and routes communications to the appropriate area for handling. 
• May act as a conduit back to internal teams for provider input and feedback. Supports development and implementation of policy changes and communicates the provider perspective when representing the department on cross-functional teams, corporate initiatives, and tactical objectives. 
• Maintain current market knowledge, industry knowledge and innovation awareness to drive the change needed to transform the way healthcare is delivered and reimbursed.
• Other duties as assigned or requested.

EXPERIENCE

Required

• 7 years of experience in healthcare / insurance industry​