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 performance requirements, and knowledge of reimbursement methodologies and models as well as financial and analytical modeling. 
• Public speaking skills.  
• Process/quality improvement and issue resolution skills. 
• Strong written and oral communication and organizational/project management skills
• Broad knowledge and working experience with various software packages such as Microsoft PowerPoint, Excel, Word. 
• Knowledge of required compliance with Centers of Medicaid and Medicare services (CMS) laws and regulations, policies and guidelines regarding Medicare Advantage and Medicaid plans; HIPAA privacy and security regulations.

EDUCATION

Required

• Bachelor’s degree in Business or Healthcare-related field or relevant experience and/or education as determined by the company in lieu of bachelor's degree.   

Preferred

• None

LICENSES or CERTIFICATIONS

Required

• None

Preferred

• None

Language (Other than English):

None

Travel Requirement:

Less than 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office- or Remote-based

Teaches / trains others

Occasionally

Travel from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Occasionally

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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