Account Manager for Provider Groups - Remote from So. Missouri
UnitedHealth Group
- Overland Park, KS
- Permanent
- Full-time
- Educate providers to ensure they have the tools needed to meet quality, coding and documentation, and total medical cost goals per business development plans
- Develops strategies and create action plans that align provider pools and groups with company initiatives, goals, quality outcomes, program incentives, and patient care best practices
- Drive processes and improvement initiatives that directly impact revenue, HEDIS/STAR measures and quality metrics, coding and documentation process and educational improvements
- Conduct new provider orientations and ongoing education to provider and their staff on healthcare delivery products, health plan partnerships, processes, and tools
- Use and analyze data to identify trends, patterns and opportunities for the business and clients, and collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues
- Conduct provider meetings to share and discuss reporting data and analysis, issue resolution needs, implement escalation processes for discrepancies, and handles or ensures appropriate scheduling, agenda, and materials
- Collaborates with internal clinical services teams, alongside operational leaders leaders, to monitor utilization trends to assist with developing strategic plans to improve performance
- Assists provider groups with investigating standard and non-standard requests and problems, to include claims and member support services
- Maintains effective support services by working effectively with the medical director, operations, and cross functional teams, and other departments
- Demonstrate understanding of providers' business goals and strategies in order to facilitate the analysis and resolution of their issues
- Performs all other related duties as assigned
- Solid analytical skills required to support, compile and report key information
- Drive processes that directly impact Revenue, HEDIS/STAR measures and Quality Metrics, and total cost of care, as appropriate
- Use data to identify trends, patterns and opportunities for the business and clients. Develop business strategies in line with company strategic initiatives
- Engage provider staff and providers in analysis and evaluation of functional models and process improvements; identify dependencies and priorities
- Evaluate and drive processes, provider relationships and implementation plans
- Produce, publish and distribute scheduled and ad-hoc client and operational reports relating to the performance of related metrics and goals
- Collaborate with internal leaders to foster teamwork and build consistency throughout the market
- Serves as a liaison to the health plan and all customers
- Requires strong presentation skills, problem solving and ability to manage conflict and identify resolutions quickly.
- Have the ability to communicate well with physicians, staff and internal departments
- 4+ years of comparable work experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree
- 3+ years of experience in a related medical field or health plan setting (network management, contracting and/or recruitment, or provider relations)
- Solid working knowledge of Medicare health care operations including HEDIS, CMS reimbursement models, and Medicare Advantage
- Understanding of IPAs, Clinically Integrated Networks, Medicare Shared Savings Programs, capitation/value-based contracting, and narrow networks
- Proficiency in Microsoft Word, Excel and PowerPoint
- Knowledge of state and federal laws relating to Medicare
- Demonstrated ability to develop long-term positive working relationships
- Demonstrated ability to communicate and facilitate strategic meetings with groups of all sizes
- Demonstrated ability to work independently, use good judgment and decision-making process
- Demonstrated ability to conduct performance evaluation to identify performance measures or indicators and the actions needed to improve or correct performance, relative to the goals
- Demonstrated ability to resolve complete problems and evaluate options to implement solutions
- Proven solid business acumen, analytical, critical thinking and persuasion skills
- Demonstrated ability to adopt quickly to change in an ever-changing environment
- Proven solid verbal and written communication skills
- Demonstrated ability and willingness to travel, both locally and non-locally, as determined by business need
- Ability to travel 25% of the time
- 5+ years of in a healthcare related field
- Demonstrated ability to act as a mentor to others
- Ability to push or pull heavy objects using up to 25pounds of force
- Ability to stand for extended periods of time