Description: The Provider Experience Account Manager develops, manages and sustains relationships between KP-MAS (Health Plan and MAPMG) and a select group of assigned providers to ensure satisfaction, problem resolution and personal attention. The primary interaction will be with external facilities and physicians but could also involve management and frontline Health Care workers. Plan, develop and execute provider satisfaction strategies.
- Responsible for the provider experience for a select group of providers once the contract is executed.
- Develops strategic relationships with select providers.
- Monitors provider contracts to ensure contract commitments are met.
- Acts as a Liaison between the provider and claims processing units.
- Understands and provides input to KP-MAS strategies as it relates to network development.
- Develops and manages provider projects, including defining deliverables and key milestones.
- Assists in the development of provider satisfaction success measures.
- Identifies needed resources for provider issues; assists in defining and assigning major project roles.
- Identifies barriers/constraints/risks to providers and provides recommendations to mitigate.
- Excellent ability to work effectively and creatively within the organization to resolve problems.
- Participates in Joint Operating Committees.
- Participates in both clinical and operational meetings as needed.
- Facilitates improvement efforts, and develops implementation recommendations.
- Facilitates collaboration with diverse groups and individuals to influence provider strategic planning and execution.
- Develops, maintains and effectively manages internal relationships at all levels across the organization.
- Acts as primary contact for external providers and their office staff.
- Identifies provider trends, conducts market intelligence to understand key issues and reports to leadership.
- Other duties as assigned.
- Minimum of five (5) years of health care experience with at least three of those years in one of the following areas: provider relations, account management, operations management, contract design/negotiation, or claims. Education
- Bachelor's degree or four (4) years of directly related experiencerequired.
- High School Diploma or General Education Development (GED). License, Certification, Registration
- Exceptional oral and written communication skills
- Excellent presentation skills
- Exceptional influencing and partnering skills at all organizational levels required
- In-depth knowledge of health care issues and a variety of facility, hospital, or physician office procedures, concepts and practices
- Strong knowledge of health care industry and financing mechanisms
- Strong knowledge of claim processing, adjudication and payment methodologies
- Strong knowledge of various coding and claims processing systems and approaches.
- Master's degree.