Philadelphia, Pennsylvania
Network Account Executive Job Opening in Philadelphia, Pennsylvania - Position Purpose: 4-8 Week Assignment in the Southeastern PA area. Perform health plan provider orientations and conduct ongoing educational outreach with a focus on improving quality and financial outcomes within the provider network. Act as a liaison between providers and the health plan to enhance the business relationship.
Conduct initial provider orientations as well as ongoing educational outreach
Educate providers regarding policies and procedures related to referrals, claims submissions, credentialing documentation, Electronic Health Records, Health Information Exchanges, and Electronic Data Interface
Enhance account relationships by investigating, documenting and resolving provider matters and effectively handling and responding to account changes and correspondence
Engage providers and educate them on Patient Centered Medical Home initiatives
In collaboration with Informatics and Care Management teams, perform detailed Health Benefit Ratio (HBR) analyses, Health Effectiveness Data Information Set (HEDIS) analyses and create reports for provider. Review provider performance by quantitative metrics and qualitative factors
In collaboration with Informatics and Care Management teams, create and communicate milestone documents, dashboards and success or improvement metrics
Act as a liaison between the provider and health plan ensuring a coordinated effort in improving financial and quality performance
Provide information and status updates for providers regarding incentive agreements
Perform other contracting duties as requested, including but not limited to recommending changes to pricing of covered services, submitting changes to provider related database information and assisting in the completion of special projects
Ability to travel
Qualifications
Education /Experience: Bachelor?s degree in Health Care Administration, Business Administration, Clinical Sciences, related filed or equivalent experience.5+ years of combined Medicare managed health care and provider network management experience. Advanced knowledge of Microsoft Excel. Clinical or health information management experience preferred.
License: Valid driver?s license
Gordon Policy Group is an equal opportunity employer that is committed to diversity. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status other characteristic protected by applicable law.
Primary Location: USA- Southeastern PA
Organization: Gordon Policy Group
Schedule: Four -Eight Week assignment
Job Type: Full-time
Job Location:
Philadelphia, PA
Required education:
Bachelor's
Required experience:
Medicare managed healthcare and provider network management with clinical or health information management: 5 years
Required license or certification:
Valid Driver's license
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