Account Executive

• Develop strategic partnerships between the health plan and the contracted provider networks serving our communities
• Cultivate client relations and collaborate with providers to ensure delivery of the highest level of care to our members
• Participate in the development of network management strategies
• Creates strategic initiatives for performance improvement
• Conducts regular in-person visits with physicians to provide real-time support, discuss performance metrics, and identify opportunities for improvement in patient care and clinical practices
• Focuses on value-based care model initiatives, collaborating with physicians to identify and align to performance-based agreements that incentivize better patient outcomes, cost-efficiency, and quality care
• Uses data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets
• Builds strong interpersonal relationships with cross functional teams both externally (provider) and internally (health plan)
• Expert proficiency in tools and value-based performance (VBP) in order to educate providers resulting in improved provider performance
• Resolves provider issues as needed for resolution to internal partners and creating efficiencies to prevent continued concerns
• Receive and effectively respond to external provider related issues
• Investigate, resolve and communicate provider high dollar and high volume provider claim issues and changes
• Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
• Evaluates provider performance and develops strategic plan to improve performance
• Present detailed HBR analysis and create reports for Joint Operating Committee meetings (JOC)
• Acts as a lead for the external representatives
• Coaches and trains external representatives

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