Senior Network Account Manager

About the role

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.

Responsibilities

• 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
• Provide effective education and communication of Healthfirst 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
• 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
• Ability to 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
• Solid understanding of terms of contracts and how they should be applied: financial, amendment, termination, etc.
• Knowledgeable review to ensure accuracy of future claims
• Ability to guide and facilitate the team’s contracting process from start to finish

Requirements

• Medicare and/or Medicaid managed care experience
• Provider office operations experience

Qualifications

• Bachelor’s degree

Skills

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

Benefits

Healthfirst offers a full range of benefits including medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements).

Pay

Hiring Range: Greater New York City Area (NY, NJ, CT residents): $122,900 - $188,020
All Other Locations (within approved locations): $105,100 - $160,480
As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

Schedule

Not specified