Network Relations Account Manager
1 month ago
Summary:
Serves in an account management (non-sales) role as the primary business to business liaison between ConnectiCare and its provider network and is responsible for all interactions between the organizations. Continuously educates provider community about ConnectiCare and its policies and procedures. Build and develop partnerships with ConnectiCare's Tier I and Tier II providers, driving engagement and advocacy. The Account Manager develops and maintains an ongoing collaborative relationship with providers, based on mutual respect, high quality outcomes, patient satisfaction and reporting. The Account Manager plays a vital role in achieving positive outcomes in the market.
Responsibilities:
- Develop and maintain positive business relationships with Tier 1 providers, and support of Tier II providers in alignment with departmental objectives.
- Oversee the compliance and participation of network physicians to ensure providers are responding timely and accurately to global requests made by any and all departments within the organization.
- Actively manages and facilitates external Provider Collaborative meetings; including organizing and internal preparation; in order to improve overall population health in the areas of total medical cost management, quality and patient satisfaction.
- Responsible for oversight of the resolution of any and all escalated problems, including those identified by the providers, and those identified internally that have an impact on the assigned provider organizations. Coordinates with internal business partners to assist as appropriate, including creating project plans, issue logs, conference calls, etc.
- Works to continually shape the Network landscape, by education to all stakeholders in the market.
- Ability to collaborate with the Contracting team to review contracts to gain understanding and communicate intent to providers.
- Drives continuous provider education and knowledge about ConnectiCare plans and products, ensuring full understanding; promote wholesale policy change, and develop educational programs on a routine basis.
- Balance the interests of CCI with providers.
- Performs other related duties and projects as assigned.
- Bachelor's Degree required, or equivalent combination of education and experience
- At least 3 - 5 years of previous experienced in managed care, health plan operations in provider contracting, provider relations, customer service, coding or claims
- Ability to work independently, prioritize and manage projects in a demanding, fast paced environment
- Strong problem-solving skills coupled with the ability to facilitate resolution to issues
- Understanding of health insurance products, claims payment and reimbursement methodologies
- Excellent communication skills, including presentation required
- Strong interpersonal skills including ability to affect change in a dynamic health care environment required
- Demonstrated proficiency in MS Office suite as well as other related software applications
- Travel 50% of the time using own transportation when necessary required
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