Provider Account Liaison - Delaware Medicaid

Company :

Highmark Inc.

Job Description : 

JOB SUMMARY

We are actively seeking a highly skilled and dedicated Provider Account Liaison to be the primary liaison between Highmark Health Options and our contracted providers within the Delaware Medicaid network. This pivotal role is primarily focused on building and fostering relationships and ensuring providers are thoroughly informed about our policies, procedures, and all crucial information detailed in the provider manual. By proactively educating and engaging our providers, you will be instrumental in preventing issues, fostering compliance, and ultimately enhancing the overall provider experience and quality of care for our members.

You will play a critical role in building and fostering strong, collaborative relationships across our provider network, actively contributing to network management, training, monitoring, and enforcement of company policies and procedures, all while increasing provider efficiencies. You will also address and help resolve complex trending claims issues that may arise from a lack of understanding or system challenges.

This role is a remote based role. You will need to be a resident of Delaware.

ESSENTIAL RESPONSIBILITIES

• 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.
• Lead and manage activities to implement the provider network and contracting strategies for the large/complex provider groups within the region.  
• Partner with key provider groups to gain buy-in and “sell” strategic initiatives for the purposes of piloting and implementing alternative care/reimbursement models.  
• 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.
• Drive the high level interactions and direction of the Pay for Value (P4V) relationships.  
• Communicate with the appropriate business leaders on the P4V program participation, opportunity, performance, and progress.  
• 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.

EDUCATION

Minimum

• Bachelor's Degree - Business, Healthcare related field

Substitutions

• Prior experience in provider relations, healthcare or insurance industry

Preferred

• None

EXPERIENCE

Minimum

• 5 - 7 years of experience in the healthcare/insurance industry

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

LICENSES AND CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• 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 modeling
• 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

TRAVEL REQUIREMENT
25% - 50%

PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS 

Position Type   

Remote

Office-Based Positions
An employee in this position works in an office environment.  The position frequently requires the employee to communicate effectively with others both inside and outside the workplace (e.g., in person, via telephone, via email).  The employee must be able to understand, interpret and analyze data, solve problems, concentrate, and research, use available technological resources and systems (e.g., computers and computer programs), multi-task, prioritize, and meet multiple deadlines to complete essential tasks.  The employee generally works in a fast-paced and frequently stressful environment, must attend work on a regular and reliable basis as well as adhere to all workplace policies, and may be called upon to work outside regular business hours.    

Teaches/Trains others regularly

Occasionally

Travels regularly from the office to various work sites or from site-to-site

Occasionally

Physical Work Site Required

No

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. 

Pay Range Minimum:

$50,200.00

Pay Range Maximum:

$91,200.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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