Dir Prvdr Acct Mgmt

Dir Prvdr Acct Mgmt at One Call Dir Prvdr Acct Mgmt at One Call in Charleston, West Virginia Posted in 1 day ago.

Job Description:

Description & Requirements

JOB SUMMARY

Responsible for leading growth, maintenance and implementation of cost-effective provider contracting arrangements. This includes network strategies and strategic account management for our national network of providers. Serves as leader to the manager and Provider Account Management personnel, overseeing the development of network-wide strategies, contracts, and strategic accounts to improve efficiency and drive revenue growth. Under the direction of the Vice President, Provider Networks, s/he performs all critical functions necessary to assess, develop, maintain and/or improve provider contract/Account adequacy and performance.

ESSENTIAL DUTIES & RESPONSIBILITIES

Direct team activities while working with the manager on items, including Key Account updates, cross functional projects, savings initiatives, revenue growth, and new product opportunities. Guide the manager in working with team to maintain critically important providers, integrated provider systems, and provider networks that support business needs and align with corporate priorities while working to identify gaps in coverage with a plan to address. Support the manager leading the team in building and maintaining productive relationships with key accounts while enforcing One Calls value propositions in the marketplace. Support team with open conversation on areas of improvements and cost savings. Parter with Manager to lead Account Managers to support negotiations for innovative providers and strategically contract alternatives & key accounts. Lead Managers in reporting and forecasting key operational functions and data analyses necessary to support provider contracts/current key accounts so the One Call's work units can create complete, timely, and accurate workflows and support for provider networks and contractual provisions working with team to ensure they are as effective as possible. Meet with managers to discuss/report up on any potential regulatory changes, analyze contractual language periodically, as well as the parties' obligations and overall relationships to ensure agile response to market conditions, necessary regulatory compliance, and adequate network access. Support manager to share and maintain thorough knowledge of existing and emerging contract arrangements, regulations, and pricing trends; renegotiate contracts where improvements are needed. Lead and meet with managers on regular cadence to monitor contract performance of providers; analyze relevant reports; identify reporting, administration, reconciliation, and systems opportunities for improvement; and recommend enhancements so contracts can be administered accurately, and ongoing provider performance can be effectively measured. Support manager on cross functional teams/discussions to review and identify new opportunities for revenue growth and savings, maintaining open communication and providing consistent updates to key stakeholders Report out to VP/ExCo any SWOT (Strengths, Weaknesses, Opportunities, Threats) that could have impact on business and work with managers to coordinate response teams Work with manager, for reporting purposes, to prepare and present current target accuracy on specific goals and issue trends to team during regularly scheduled performance reviews to maintain year-end financial goals Lead efforts to address escalated issues, working directly with VP/ExCo level to ensure challenges are identified, resolution is put in place and monitoring for closure Support manager and team as needed during annual business reviews with key accounts, providing assistance and information to further strengthen relationships Work with manager to identify/review key strategic providers and execute contract amendments, to include new locations, modalities, and services lines Additional duties as assigned/business needs require

EDUCATIONAL AND EXPERIENCE REQUIREMENTS

Bachelor's degree (B.A. or B.S.) and/or a Master's degree (M.A., S. or M.B.A.) in Business or Accounting. Minimum of five (5) years of experience in health care services. Three (5) years of management experience. Five (5) years of experience in provider relations and/or Account/vendor Management, or a related area. A combination of equivalent education or experience.

ESSENTIAL KNOWLEDGE, SKILLS & ABILITIES

Minimum of 10 years of successful provider contracting and/or Account Management experience including: Excellent provider relations experience and thorough knowledge of managed care practices and provider contracting, either in a provider or payor capacity. Extensive experience and thorough knowledge of provider reimbursement methodologies, financial modeling, business analytics and reporting, provider coding and billing procedures, and related concepts and terminology. Thorough knowledge of insurance terminology, concepts, and benefits issues, including actuarial and underwriting relationships to provider rates and services, member benefits, and cost sharing attributes. Excellent verbal communication skills, including listening effectively, persuasive negotiation skills, and communicating strategic and technical issues to individuals and in presentations to groups. Ability to comprehend and interpret managed care contract terminology and thorough knowledge of quantitative analysis related to provider reimbursement. Experience articulating and representing a compelling vision of an organization's strategic direction with provider relationships. Management experience demonstrating effective leadership that results in achievement of desired results. Ability to work in an environment that aligns with the company's diversity, equity, inclusion and belonging standards. Ability to work both independently and as part of a team in a fast-paced environment. Demonstrate our core values of Think Big, Go Fast, Deliver Awe, Win Together, and Care Deeply

PHYSICAL/MENTAL DEMANDS & WORK ENVIRONMENT

This position will be performed in the colleague's home. Work-from-home requirements include the colleague's ability to set up computer equipment within their home office. This job is primarily sedentary and may involve repetitive motions; the colleague must be able to remain in a stationary position for extended periods of time, operate a computer and other office equipment, assess information and files stored electronically, and converse/exchange accurate information with others, simultaneously. The colleague must be able to discern text displayed on a monitor, input data into specific fields using a keyboard, and adjust focus to distances of up to three feet. The colleague must have the ability to learn new tasks, follow established processes, maintain focus, complete tasks independently, complete multiple tasks simultaneously, communicate professionally with colleagues and customers, and complete tasks in situations that have a speed or productivity requirement. The colleague must be able to manage moderate to significant mental stress as a result of, but not limited to, a dynamic and heavy workload. Please be advised that job descriptions typically change over time as business needs, job requirements, and employee skill levels change. As such, One Call retains the right to change or assign other duties to this position at any time. Director Provider Account Management Senior managerial role - directs and controls activities of a broad functional area through several department managers. Has overall control of planning, staffing, budgeting, managing expense priorities, and recommending and implementing changes to methods. Participates with other senior managers in establishing strategic plans and objectives, makes final decisions on administrative/operational matters and ensures effective achievement of objectives. Works on complex issues where analysis of situations or data requires an in-depth knowledge of the business and/or industry. Participates in corporate development of methods, techniques and evaluation criteria for projects, programs, and people. Erroneous decisions may result in critical schedule delays - jeopardizing overall business activities. Ensures budgets and schedules meet corporate requirements. Regularly interacts with executives and/or major customers. Interactions frequently involve special skills, such as negotiating with customers or management or attempting to influence senior level leaders regarding matters of significance to the organization. Typically requires 10 plus years of experience in a leadership role. We are an equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, nationality, disability status, protected veteran status, or any other status protected by law.