Job Information

AdventHealth Account Manager Network Operations PHSO in Altamonte Springs, Florida

Description

AdventHealth Corporate

All the benefits and perks you need for you and your family:

  • Benefits from Day One

  • Career Development

  • Whole Person Wellbeing Resources

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Full-Time

The role you’ll contribute:

The Account Manager manages and coordinates the integration of Health Plans, Government Programs, Employers, MA and Individual contracting with the Population Health Services Organization (PHSO) and AdventHealth provider network. The account manager is responsible for supporting the business growth, and retention by developing and maintaining effective account management strategies that achieve contract outcome success. The populations will typically range between 25 – 75K+ lives with complicated plan designs, sensitive administrative duties in multiple regions. In addition, the Account Manager participates, and leads elements of, strategic and general business planning for the growth and development of the PHSO. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

The value you’ll bring to the team:

  • Operational Management of accounts, products or programs: facilitate work teams, track deliverables, problem solve, issue resolution

  • Develop and manage effective primary relationships with key stakeholders, supports professional negotiation, responsive communication, problem resolution to meet customer expectations.

  • Work with clients to understand their concerns and needs and act as liaison between the PHSO departments and the customers to initiate plan improvements, escalate and resolve administrative inconsistencies timely and implements corrective action plan when needed.

  • In preparation for renegotiations, gather underwriting data, review claims experience, review the recommended renewal action and prepares a summary justifying the renewal and recommending changes when appropriate.

  • Reviews contract provisions and administrative issues with leadership and pursues opportunities to improve profitability and retention.

  • Reviews proposal requests, providing all appropriate information to leadership, and present or assist in the presentation of the proposal to the Health Plans or Employers. Follow expectations for tracking activity in designated software program.

  • Supports and is actively involved with the provider reps and negotiation teams in the acquisition, submission and implementation of accounts. Supports joint product development process for Government, Commercial, MA and Individual products.

  • Lead and coordinate the submission, set up and implementation of assigned new populations with the PHSO teams.

  • Partners with the Health plans to facilitate the enrollment process, which may involve preparation of enrollment materials, conducting enrollment meetings or being present at benefit fairs.

  • Serve as mentor and Liaison with all service lines offer by the PHSO.

  • Support company initiatives by implementing changes and/or participating in project work.

  • Educates the PHSO teams on the strategies and operations of new business.

  • Responsible for the financial performance and implementation of corrective action plans.

  • Works jointly with PHSO teams to manage program metrics, monitor performance, and take appropriate action.

  • Manages or facilitates the cross-functional and cross-organizational work teams needed to grow and support the PHSO and AHS Division Initiatives.

  • Support program strategic meetings, such as Joint Operating Committees, Boards or other Committees.

  • Provide product or program subject matter expertise: distribute news, maintain & resources; assist in the creation of education and materials, compile research.

  • Program process development: learn, create, refine, document & train on procedures, desk reference manuals, etc.

  • Maintain network listings: audit, submit changes to data management, clients, CMS, etc.

Qualifications

The expertise and experiences you’ll need to succeed:

  • Bachelor’s degree in a related field, such as Business, Marketing, or Communications,

  • A minimum of three years of experience in the field of health insurance (with an HMO, health insurer, TPA or broker) sufficient to yield the knowledge requirements above

  • Registered health underwriter or valid State of Florida health insurance license preferred

  • Ability to work in a matrix-management environment to achieve organizational goals

  • Basic knowledge of all aspects of typical health plan operations including customer service, network management, data exchange, claims processing, sales and underwriting, marketing, benefit plan design, medical management, finance, risk adjustment, regulatory oversight, and compliance. Advanced knowledge in at least two of these fields.

  • Knowledge of the health insurance/managed care industry including products (commercial large and small group, individual, Medicare Advantage, self-funded), market segments, competitive landscape, and applicable state and federal statutes and regulations

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Category: Operations

Organization: AdventHealth Corporate

Schedule: 1 - Day

Shift: PHSO

Req ID: 22027917

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.