Account Executive, Provider Network - Health First Health Plans, Full-time
About the Job
To be fully engaged in providing Quality/No Harm, Customer Experience, and Stewardship by serving as the primary contact for assigned providers in the network to build and maintain relationships for better collaboration and performance.
Work Location\: This position does require travel around 80% of the time within Central Florida. Most travel will be within Palm Bay and Indian River County. The remaining work time will be working remotely.
- Conduct assigned provider office visits to review performance, resolve issues, and facilitate credentialing applications. Educate providers on plan benefits, eligibility, and policies & procedures.
- Maintains a thorough understanding of provider performance reporting to effectively communicate performance and expectations.
- Develop and conduct meaningful provider orientation.
- Maintains provider data integrity\: correct contact information, location changes, including monitoring of provider credentialing, demographics, additions, and terminations. Communicates to provider network operations team.
- Responsible for provider network education in regards to technology\: portal, electronic claim submission, etc.
- Suggests providers for recruitment to address gaps, member access, or network adequacy challenges if applicable.
- Record daily call activity in Salesforce. Achieve average minimum call expectations of 140 monthly to build and maintain strong business relationships with provider offices.
- Represent Health First Health plans in a professional, ethical manner.
- Identifies knowledge gaps and participates in the development of educational material to improve collaboration and provider engagement.
- Outreach to proactively address & reduce provider-related issues and follows up with network operations team until resolution.
- Documents and reports provider-related service expectations and obstacles to support operational improvements.
- Support administrative requirements including the development of provider education collateral, organizing educational sessions, providing field intelligence, and documenting provider visits in salesforce in a timely manner.
- Coordinates, attends, and participates in meetings. Assist with the coordination of meeting by creating agendas, content, presentations, and communication.
- Provides ongoing training to assigned providers on resources (ie. portal) to assist with authorizations, claims, member benefits, etc.
- Education includes, but is not limited to coordinating provider orientation, onboarding, continuous training on policies & procedures, and HFHP resources.
- Supports finance/medical economics team to reduce medical expense by executing actions necessary to successfully complete initiatives
- Communicates and accountable for year over year performance improvement initiatives that pertain to Care Gaps, documentation, formulary adherence, OON reduction, etc.
- Meet agreed upon goals as outlined from operational reporting
- Associate’s degree required but Bachelor’s degree preferred.
- Experience in related field with physician offices, managed care, or health insurance preferred or equivalent combination of education and experience
- Proficient Microsoft office products (Excel, PowerPoint, Word, Outlook)
- Excellent customer service skills
- Demonstrated interpersonal/verbal communication skills
- Problem solving and multi-tasking kills
- Time management and organizational skills
- Represent HFHP in ethical and professional manner
- Ability to work independently and spend 80% of time in the field and also work in a team environment
- Valid driver’s license and proof of auto insurance compliant with corporate policy
- Moderate travel within the service area
- Computer work
- Ability to lift, carry, or move objects <20lbs- light lifting.
- Comfortable working in a fast- paced environment
- Ability to handle service issues in a professional timely manner
- Maintain confidentiality of customers, PHI, and organization.
- Ability to handle sensitive issues with tact and diplomacy.