Senior Network Account Manager, FQHC

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.

• 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

• Effective education and communication of Heatlhfirst 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

• 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

• 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

• Understanding terms of contracts and how they should be applied: financial, amendment, termination, etc

• Process for approval of changes in terms

• 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

• Guide and facilitate the team’s contracting process from start to finish

Minimum Qualifications:

• HSD/GED

• Provider office operations experience

• Ability to understand Provider claims reimbursement

• Contract negotiation experience

• Professional Writing skills (Letter writing, Memo and Email)

WE ARE AN EQUAL OPPORTUNITY EMPLOYER.  HF Management Services, LLC complies with all applicable laws and regulations. Applicants and employees are considered for positions and are evaluated without regard to race, color, creed, religion, sex, national origin, sexual orientation, pregnancy, age, disability, genetic information, domestic violence victim status, gender and/or gender identity or expression, military status, veteran status, citizenship or immigration status, height and weight, familial status, marital status, or unemployment status, as well as any othe