Note: The job is a remote job and is open to candidates in USA. UnitedHealth Group is a global organization that delivers care aided by technology to help millions of people live healthier lives. The Senior Account Manager will develop and sustain relationships with stakeholders, analyze data for operational planning, and drive process improvements to enhance performance and profitability of physician practices.
Responsibilities
- 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, 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 solid 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
Skills
- 3+ years of experience in a related medical field or health plan setting (network management, contracting and/or recruitment, or provider relations)
- 2+ years of experience with state and federal laws relating to Medicare
- 2+ years of experience with Medicare health care operations including HEDIS, CMS reimbursement models, and Medicare Advantage
- 1+ years of experience with IPAs, Clinically Integrated Networks, Medicare Shared Savings Programs, capitation/value-based contracting, and narrow networks or similar related experience
- Advanced level of proficiency in Microsoft Word, Excel and PowerPoint
- Ability to travel 25% of the time
- Access to reliable transportation & valid US driver's license
- Demonstrated ability to act as a mentor to others
- 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 adopt quickly to change in an ever-changing environment
- Proven solid business acumen, analytical, critical thinking and persuasion skills
Benefits
- A comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution (all benefits are subject to eligibility requirements)
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