Senior Account Manager

About the role

The Senior Account Manager has geographic responsibility for the quality and economic performance of the physician practice with the goal of developing a high performing provider network within the State of Kansas. This includes analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning.

Responsibilities

• Educate providers to ensure they have the tools needed to meet quality, coding and documentation, and total medical cost goals per business development plans
• Develops strategies and create action plans that align provider pools and groups with company initiatives, goals, quality outcomes, program incentives, and patient care best practices
• Drive processes and improvement initiatives that directly impact revenue, HEDIS/STAR measures and quality metrics, coding and documentation process and educational improvements
• Conduct new provider orientations and ongoing education to provider and their staff on healthcare delivery products, health plan partnerships, processes, and tools
• Use and analyze data to identify trends, patterns and opportunities for the business and clients, and collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues
• Conduct provider meetings to share and discuss reporting data and analysis, issue resolution needs, implement escalation processes for discrepancies, and handles or ensures appropriate scheduling, agenda, and materials
• Collaborates with internal clinical services teams, alongside operational leaders, to monitor utilization trends to assist with developing strategic plans to improve performance
• Affords assistance to provider groups with investigating standard and non-standard requests and problems, to include claims and member support services
• Maintains effective support services by working effectively with the medical director, operations, and cross functional teams, and other departments
• Demonstrate understanding of providers' business goals and strategies in order to facilitate the analysis and resolution of their issues

Requirements

• Solid analytical skills required to support, compile and report key information
• Drive processes that directly impact Revenue, HEDIS/STAR measures and Quality Metrics, and total cost of care, as appropriate
• Use data to identify trends, patterns and opportunities for the business and clients. Develop business strategies in line with company strategic initiatives
• Engage provider staff and providers in analysis and evaluation of functional models and process improvements; identify dependencies and priorities
• Evaluate and drive processes, provider relationships and implementation plans
• Produce, publish and distribute scheduled and ad-hoc client and operational reports relating to the performance of related metrics and goals
• Collaborate with internal leaders to foster teamwork and build consistency throughout the market
• Serves as a liaison to the health plan and all customers
• Requires solid presentation skills, problem solving and ability to manage conflict and identify resolutions quickly
• Have the ability to communicate well with physicians, staff and internal departments

Qualifications

• 3+ years of experience in a related medical field or health plan setting (network management, contracting and/or recruitment, or provider relations)
• 2+ years of experience with state and federal laws relating to Medicare
• 2+ years of experience with Medicare health care operations including HEDIS, CMS reimbursement models, and Medicare Advantage
• 1+ years of experience with IPAs, Clinically Integrated Networks, Medicare Shared Savings Programs, capitation/value-based contracting, and narrow networks or similar related experience
• Advanced level of proficiency in Microsoft Word, Excel and PowerPoint
• Ability to travel 25% of the time
• Access to reliable transportation & valid US driver's license

Skills

• Strategic planning and analysis
• Understanding of HEDIS, Star ratings, accurate documentation and coding
• Highly developed communication skills
• Ability to develop clear action plans and drive process

Benefits

Our mission of helping people live healthier lives extends to our team members. Learn more about our range of benefits designed to help you live well.

Pay

The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Schedule

Monday - Friday, 8am - 5pm

Location

This role is remote in Wichita, KS and requires the ability to travel 25% of the time.

Application Instructions

No application instructions provided.