Provider Account Manager

Company :

Job Description : 

JOB SUMMARY

This job is the primary liaison to support identified providers in the market. The incumbent plays an active role in provider training and monitoring as well as enforcement of company policies and procedures while increasing provider efficiencies, performance, and maximizing quality (STAR/HEDIS). Responsible for reporting packages, support, escalated service, education on vendor delivered solutions and services, population health capabilities and resources, and alternative reimbursement model. The incumbent will interact with providers by telephone, email, and at times in person. They will be the primary point of contact for certain providers and are therefore responsible for facilitating inquiries. This means coordinating the troubleshooting and resolving provider complaints and ensuring that responses to inquiries are completed in a timely manner and according to established service and quality standards. 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 value-based reimbursement (VBR) programs for the organization.  To be successful, the incumbent builds relationships with and work across many departments in the Health Plan.  

This role is based in West Virginia. It will be hybrid if you are within 50 miles of an office (Parkersburg or TriDelphia). It will be remote outside of the 50 miles.

ESSENTIAL RESPONSIBILITIES

Value-Based Reimbursement Support 

• Manage relationship with select providers to proactively measure, anticipate and prevent problems and achieve corporate objectives around VBR programs and strategic initiatives with providers.  
• Assume the non-clinical lead role in the VBR performance and education for all assigned providers. Educate providers on changes to VBR programs, reporting and performance requirements, and new offerings. Meet with contacts at various levels at key physician practices to ensure appropriate levels of communication. Responsible for educating providers on initiatives focused on managing medical expense and maximizing HEDIS and STAR metrics in collaboration with internal resources.  

General Provider Support

• Ensure critical and timely communication to providers regarding Highmark’s programs, initiatives, and provider’s performance through ongoing personal contacts. Follow up on issue resolution.   
• Recommend process efficiencies, strategies for improvement, and/or solutions to align technology with business strategies.

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Internal Partnership

• Engage appropriate internal 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.  
• 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. 
• Perform Provider Relations triage function; addresses issues raised by providers and routes communications to the appropriate area for handling. 
• 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

• 5 years of experience in the healthcare/insurance industry
• 3 years of experience in presenting concepts to varying audiences
• 3 years of Project management experience or other relevant experience with high accountability for managing multiple tasks with defined deadlines

Preferred

• 5 years of experience in presenting concepts to varying audiences
• 5 years of Project management experience or other relevant experience with high accountability for managing multiple tasks with defined deadlines
   

SKILLS

• Understanding of the provider community (market knowledge) and global understanding of care delivery models and the insurance industry. 
• Ability to communicate effectively with providers and colleagues and articulate issues, problems, and solutions in a timely manner.  
• Critical thinking skills. 
• Knowledge of Highmark’s VBR programs, contract and performa