Job Description

Are you an experienced Provider Account Liaison with a desire to excel? If so, then Talent Software Services may have the job for you! Our client is seeking an experienced Provider Account Liaison to work at their office in Wilmington, DE.

Position Summary: This job is the primary liaison between provider groups in the Organization network and the corporation. Will be responsible for cultivating relationships with provider groups. This job will maintain visibility in the provider community by representing the organization at various provider functions, meetings, and collaboratives. The incumbent will play an active role in network management, training, monitoring and enforcement of company policies and procedures while increasing provider efficiencies; participate as a regional representative on key operational/product/medical management/reimbursement projects/initiatives that impact providers.

Primary Responsibilities/Accountabilities :

• Assume a leading role in the education and implementation of the provider network and contracting strategies for all assigned providers.
• Lead and manage relationship with assigned providers to proactively measure, anticipate and prevent problems as well as continually improve operational efficiencies and achieve corporate objectives around programs and strategic initiatives with providers.
• Proactively identify provider issues; recommend solutions and ensure provider receives the necessary support and resources to carry out the solutions.
• Coordinate in a matrixed liaison role with operations and support areas to ensure the appropriate development and execution of initiatives, communication needs, and issue resolution.
• Act as a conduit back to project teams for provider input and feedback on strategic initiatives.
• Work to gain consensus and incorporate necessary plan modifications.
• Assist with contracting as it relates to implementing key provider strategies.
• Engage appropriate resources, tools, analytics, and reports to enable success in the programs to drive better health outcomes, lower unit costs, and higher patient satisfaction for our members.
• Oversee administration of critical and timely communication to providers through ongoing personal contacts, on-site field visits, regional communication sessions, and meetings with professional organizations to communicate initiatives and changes.
• Develop, participate in, and support education to providers due to changing reimbursement environment, product portfolio, processing requirements, and new technology offerings.
• Meet with contacts at various levels at key physician practices to ensure appropriate levels of communication and maintain harmonious relationships.
• Maintain current market knowledge, industry knowledge and innovation awareness to drive the change needed to transform the way healthcare is delivered and reimbursed.
• Collect market intelligence to contribute to strategic planning and design of products and networks.
• Other duties as assigned or requested.

Qualifications:

• Bachelor's Degree - Business, Healthcare-related field OR prior experience in provider relations, healthcare or insurance industry
• 3 - 5+ years of experience in the healthcare/insurance industry
• In-depth understanding of the provider community (market knowledge) and global understanding of care delivery models and the insurance industry
• Knowledge of reimbursement methodologies and models, as well as financial and analytical modelling
• Public speaking/delivering presentations
• Negotiation skills
• Process/quality improvement
• Strong written and oral communication and organizational/project management skills
• Broad knowledge and working experience with various software packages such as Microsoft PowerPoint, Excel, Word
• Knowledge of required compliance with Centers of Medicaid and Medicare services (CMS) laws and regulations, policies and guidelines regarding Medicare Advantage and Medicaid plans; HIPAA privacy and security regulations

Preferred:

• 3 - 5 years of experience in presenting concepts to varying audiences
• 3 - 5 years of project management experience or other relevant experience with high accountability for managing multiple tasks with defined deadlines

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