Job description

Role Overview: The Senior Account Executive is to develop strong relationships with providers to drive for performance specifically as it relates to core providers who are on risk-based or cost sharing VBC arrangements as well as large health system contracts. Work Arrangements: • Remote - The associate must reside in Louisiana (LA) and attend site visits to provider and in office meetings in Baton Rouge. Responsibilities: • Supports network development and network management strategies. • Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication. • Responsible for participating in and implementing Provider Network education programs and materials (both internal and provider targeted) and is assigned to train, mentor and support new Account Executives. • Responsible for hospital and physician network development and management; including joint operating committees (JOC) for identified groups, oversight of necessary quality review meetings with targeted providers and/or health systems. • Responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers; including those that are most complex. • Resolve Provider disputes in a timely and compliant manner. • Responsibility for a higher number of multiple practice locations and multi-specialty practices and multiple providers. Should also include hospital systems, contracted subcontractors (DME, Vision, etc.), and ancillary providers. • Develop/implement/manage programs and projects that support/impact high dollar and high member provider groups. • Perform site visits as needed. • Oversee resolution of provider issues managed by other Provider Network support teams. • Take corrective actions required up to and including termination, following Plan policies and procedures. • Operationalizes completed contracts with advanced complexity. • Consults on VBC contracts, facilitates for success (JOCs, performance overview, etc.) with specific bonuses attached to performance improvement. • Responsible to maintain and manage Value-Based contract requirements, including but not limited to; monitoring performance standards against VBC or State program requirements, working with key stakeholders and provide oversight on applicable data-sharing or report requirements. • Responsible for hospital and physician network development and management; including JOC for identified groups, oversight of necessary quality review meetings with targeted providers and/or health systems. • General Operational Knowledge related to provider satisfaction, education, and communication with a fundamental understanding of operational items such as claims, payment integrity, provider data, credentialing, appeals disputes etc. • Support contracting for multiple product lines, including LTSS, Exchange, DSNP adequacy gaps (high complexity). • Assist with recruiting providers based on identified network adequacy gaps (high complexity). • Support of VBC negotiations; lead in VBC relationships; may lead negotiations. Education & Experience: • Associate’s degree required or 5 plus years as an Account Executive experience • Bachelor's degree preferred. • 7 years of experience if no bachelor’s degree • 5 or more years strong communication skills, financial acumen, ability to have difficult conversations. Skills & Abilities: • Strong verbal and written communication skills • Ability to deliver provider education, training, orientation, and onboarding to large groups • Relationship-building and provider account management skills • Ability to resolve provider disputes and operational issues promptly and compliantly • Analytical skills, including the ability to use data to improve provider relationships and performance • Strong collaboration skills for working with internal stakeholders and external providers • Organizational skills with the ability to manage multiple provider practices, locations, or organizations • Proficiency in maintaining provider databases and communicating additions, deletions, and corrections

Requirements

Must-haves

Supports network development and network management strategies.
Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication.
Responsible for participating in and implementing Provider Network education programs and materials (both internal and provider targeted) and is assigned to train, mentor and support new Account Executives.
Responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers; including those that are most complex.
Resolve Provider disputes in a timely and compliant manner.
Develop/implement/manage programs and projects that support/impact high dollar and high member provider groups.
Perform site visits as needed.
Oversee resolution of provider issues managed by other Provider Network support teams.
Take corrective actions required up to and including termination, following Plan policies and procedures.
Operationalizes completed contracts with advanced complexity.
Consults on VBC contracts, facilitates for success (JOCs, performance overview, etc.) with specific bonuses attached to performance improvement.
Responsible for hospital and physician network development and management; including JOC for identified groups, oversight of necessary quality review meetings with targeted providers and/or health systems.
Support contracting for multiple product lines, including LTSS, Exchange, DSNP adequacy gaps (high complexity).
Assist with recruiting providers based on identified network adequacy gaps (high complexity).
Support of VBC negotiations; lead in VBC relationships; may lead negotiations.
Associate’s degree required or 5 plus years as an Account Executive experience
7 years of experience if no bachelor’s degree
5 or more years strong communication skills, financial acumen, ability to have difficult conversations.
Strong verbal and written communication skills
Ability to deliver provider education, training, orientation, and onboarding to large groups
Relationship-building and provider account management skills
Ability to resolve provider disputes and operational issues promptly and compliantly
Analytical skills, including the ability to use data to improve provider relationships and performance

Nice-to-haves

Bachelor's degree preferred.

Application prep

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Platform: phenom
Effort: medium

Benefits

Benefits detected in the listing.

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