Physician Account Executive - est/blt - Remote Eligible

Provider Account Executive

UPMC Health Plan is looking for a Provider Account Executive in the Southeast, PA area to join the team! Candidates must be located in Philadelphia or surrounding counties to be considered. This is a full time work from home position that requires travel to provider sites in Philadelphia, Montgomery, Bucks, Delaware and Chester counties as well as occasional travel to a UPMC office.

The Provider Account Executive will: manage relationships with Home and Community Based Service (HCBS) providers within the Southeast and surrounding area, provide education and support to assist Providers to improve quality of service, assist the provider in developing action plans, support claims/payment inquiries, and support ongoing provider education. Work with a broad spectrum of UPMC Health Plan personnel, network providers, and external resources to complete all tasks related to network management projects, goals and objectives.

Responsibilities:

• Monitor ongoing provider performance and provide education to improve compliance and quality.
• Provide information on plan resources to assist.
• Meet with providers to review/update current information and review regulation compliance.
• Identify, document and distribute best practice information.
• Manage special projects assigned by manager and department director.
• Meet deadlines and turnaround times set by manager and department director (these deadlines and turnaround times will, at times, require the employee to work until the project is completed, meaning extended daily work hours, extended work weeks, or both).
• Recruit, contract, orient new providers as needed/assigned.
• Assist Manager in coordination of staff development and Provider training.
• Act as liaison between providers and key UPMC depts, ie; Service Coordination, Provider Monitoring, FWA, Claims, etc.
• Assist providers to resolve issues related to billing, authorizations, regulation compliance, etc.
• Ensure provider submission of acceptable compliance related Correction Plan

Qualifications:

• B.A. degree in business, health care, finance, or related field or 5 years of experience in managed care/HCBS provider setting required.
• Excellent verbal and written communication skills, analytical and organizational skills are required.
• Excellent project management, analytical, organizational, and customer service skills are required.
• Extensive problem-solving experience is required.
• Presentation experience and experience working with HCBS providers.
• Goal-oriented and have experience with development and implementation of action plans.
• Leadership skills are desired.
• Ability to work within an aggressive service-based environment.
• Ability to continuously interact effectively with all Health Plan departments is critical.
• Ability to effectively manage relationships with assigned strategic practices and keep accurate records of all activity for reporting purposes.
• Ability to develop and analyze focused action plans for key accounts.
• Minimal direction required.
• Ability to present information to management in a clear and professional manner.
• Results-oriented and self-motivated.
• Licensure, Certifications, and Clearances: UPMC is an Equal Opportunity Employer/Disability/Veteran