Work Arrangements: This position is a remote field based position. Must reside in South Carolina and will make provider visits throughout the state.
Job SummaryThe primary responsibility of Account Executive Sr. 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.
Essential Functions:- 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 and implementing Provider Network education programs and materials (both internal and provider targeted) and is assigned to train, mentor and support new AE's.
- 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 joint operating committees (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.
- Bachelor's Degree preferred.
- Preferred Experience Level (if different from minimum required): Seven years' experience if no bachelor's degree7 years experience if no bachelor's degree.
- Five (5) or more years strong communication skills, financial acumen, ability to have difficult conversations.
For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.
Our Comprehensive Benefits PackageFlexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
