The Account Manager’s primary focus is to establish, maintain and grow positive business relationships with existing payer accounts, as well as develop new business opportunities, manage on-going credentialing, contracting and program management responsibilities and evaluate and resolve issues related to payer performance and adherence to contract terms.
II. PRIMARY DUTIES AND RESPONSIBILITIES
1. Establish, maintain and grow business relationships with existing payer accounts, including but not limited to, opportunities to be a preferred or exclusive network provider. Identify and secure network participation opportunities in emerging markets. Negotiate with payers to secure favorable pricing, preferred/exclusive provider status and provider obligation terms (i.e. timely filing).
2. Develop and implement programs designed to meet the needs of payers, increase the value of services delivered and drive profitable growth for the company, including but not limited to, developing a value proposition and sales strategy to increase patient referrals from Utilization and Case Management teams at existing payer accounts.
3. Coordinate and oversee the enrollment of new patients referred by payers to ensure services are provided timely and with a high level of care. Coordinate member outreach campaigns to drive continual growth with existing payer accounts. Report performance metrics related to patient conversion and timelines of services provided and develop plans and strategies to improve performance, as needed.
4. Manage the application, credentialing and health plan filing processes, ensuring that all information is submitted timely and accurately.
5. Review payer contracts and prepare contract worksheets and reimbursement analysis documents for legal and executive review. Coordinate the contract review and execution process.
6. Review key reports to measure payer performance and adherence to contract terms. Serve as a liaison in qualifying, communicating and resolving related operational issues in a timely manner.
7. Maintain internal reference guides, directories and databases of payer participation, billing and compliance requirements and fee schedules. Maintain website access for users company-wide. Review payer manuals, newsletters, bulletins and memos and communicate pertinent requirements and changes to applicable department units. Update internal reference documents, as needed.
8. Maintain all soft and hard copy contract files.
9. Coordinate patient lead outreach campaigns to drive growth with newly contracted payers.
10. Responsible for tracking and reporting daily productivity, as well as the productivity of direct reports.
11. Performs other duties and tasks as assigned
III. REPORTING RELATIONSHIP RESPONSIBILITIES
No supervisory responsibilities
Provides work direction only
__X_ Provides work direction plus has responsibility for hiring, promotions, transfers, performance management, discipline, and discharge.
IV. MINIMUM REQUIREMENTS OR QUALIFICATIONS (To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions)
a. Education/Experience: High School Diploma or general education degree (GED); two years related experience with working knowledge of insurance or health plan credentialing, contracting or billing.
1. Language: Ability to read, analyze, and interpret medical supply publications, technical procedures, and/or training tools. Ability to write internal and external business correspondence. Ability to effectively present information and respond to questions from management, team members, and/or customers.
2. Math: Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages. Ability to apply intermediate math skills.
3. Reasoning: Ability to solve practical problems and deal with a variety of variables. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Advanced analytical reasoning to include ability to forecast exponentials within work flow processes and reason against outside factors.
4. Computer: Knowledge of Microsoft Office Applications, Access or other database software.
5. Telecommunications: ability to utilize or knowledge of call center telecommunications software
c. Licensure or Certifications required: No certifications required
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