Director Provider Account Management Job at One Call

Job Description

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.

Job Responsibility

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
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

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
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

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Director Provider Account Management

Job Description

Job Responsibility

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