Account Manager - Provider Relations (Bilingual-Mandarin and/or Canton

Employment Type

: Full-Time

Industry

: Advertising/Marketing/Public Relations



PURPOSE OF THE POSITION:

Represent and advance Affinity Health Plan interests in the provider market as the preferred plan through superior customer service and execution of provider engagement strategies.

Seeking Network Account Managers committed to developing and managing a high performance network and engaging in various provider engagement strategies that follow four core principles: Quality, Provider and Member Engagement, Administrative Efficiency, Clinical and Population Health.


ESSENTIAL FUNCTIONS:

1. Advance Affinity Health Plan in the provider market through a positive provider experience by furthering the goals important to practices:

  • Administrative ease (obtaining authorization, accurate and timely payment)
  • Clinical Support
  • Shared Mutual Goals by working directly with practices, including their office staff, to improve their clinical, quality, and member satisfaction outcomes.
  • Ensure appropriate reports are available that allow practices to better manage their member population (member roster, care plans, quality reports, etc. )
  • Effective education and communication of Affinity Health Plan benefits and policies, changes, and potential downstream effects to individual practices.

2. Deliver on Affinity Health Plan promises: ensure Providers issues and needs are responded in a timely and accurate fashion.

3. Manage territories with a business perspective that can evaluate provider performance from various perspectives.

4. Gather cooperation and support from practices on plan administration initiatives (compliance, billing rules, chart reviews, enforcement of provider responsibilities).

5. Ability to have a clear understanding of Affinity Health Plan model, its supporting systems, and how they impact provider practices. Must exhibit critical thinking skills that solve problems with a logical and analytical discipline.

6. Ability to have intimate knowledge of how provider practices operate and how plan policies may impact or be impacted by this structure and understanding of various reimbursement methodologies and how it relates to cost.

7. Identify and develop network opportunities for growth or other engagement goals and implement physician recruitment plans and strategies based on enrollment projections and geographical access needs. Complete competitive assessment of markets and assist in development and achievement of network recruiting goals.

8. Recruit targeted physicians in designated specialties and geographic areas. Develop negotiation strategies and conduct contract negotiations in conjunction with Network, Clinical and Sales groups.

10. Demonstrate a thorough knowledge of Affinity and Network Department Policy and Procedures, and Provider Agreements, including, but not limited to, contracts for FQHCs, Hospital, IPA, Article 28 Primary, Specialty and Ancillary Care, Individual Primary Care Provider, and Individual Specialty Care Provider services.

11. Ensure that all provider contractual relationships are maintained in compliance with regulatory requirements, and Affinity and Department Policies and Procedures.

12. Work closely with Network Departments and other key Departments to ensure successful implementation of Provider Agreements from initiation to approval, including provider credentialing applications, environmental site reviews, system configuration, and orientation.

13. Meet or exceed quality standards for Department documentation, including, but not limited to, Recruitment Packets, Provider Agreements, Contract Flow sheets, Provider orientation materials, welcome letters, and other correspondence.

14. Identify and develop relationships with healthcare organizations and professional associations. Participate in planning and organizing seminars, lectures, and presentations to provider groups and organizations.

15. Maintain accurate, up-to-date information regarding key contact, clinical, and other key staff at Provider practices and hospitals.

16. Assist Department Director with special projects as directed, including, but not limited to, Provider Satisfaction Surveys, Quarterly Department Newsletter, etc.

17. Performs other assigned tasks as necessary or required.


QUALIFICATIONS:

  • Minimum of a Bachelor's Degree plus two (2) years of work experience in the health care, or a related field.
  • Demonstrated knowledge and understanding of managed care concepts.
  • Demonstrated ability to communicate clearly, both in writing and verbally.
  • Ability to gather, display and analyze qualitative and quantitative data.
  • Ability to handle multiple tasks and demands concurrently, and to plan, prioritize and complete work in an efficient, productive and timely manner.
  • Effective interpersonal skills characterized by articulateness, diplomacy, and the ability to persuade and motivate others. Demonstrated ability to handle conflict and diffuse confrontational situations. Demonstrated understanding and mastery of basic negotiating skills.
  • Demonstrated ability to be resourceful and creative within defined guidelines, parameters and expectations.
  • Computer competency in word processing, spreadsheet, and basic office applications.
  • Enthusiasm and self-motivation.


Launch your career - Create your profile now!

Create your Profile

Loading some great jobs for you...