Provider Network Account Executive
Functions as a liaison between Plan and providers by responding to their needs and inquiries, and educating providers and their office staff. Perform contracting activities with providers which includes the negotiation of rates for services following special pricing procedures. Addresses routine inquiries independently and not be dependent on being told to do so. Liaison for claims issues between provider and Plan Operations. Actively engages providers in Plan Initiatives and/or goals. Develops positive working relationships with applicable provider practice staff. Develops strategies to address issues and opportunities and engages poor performing practices in meaningful dialogue to change behaviors. Conduct in person and/or phone conferences/meetings with providers. Attend required training sessions on an annual basis. Supports the Quality Management Department with the credentialing and re-credentialing process, and the investigation of member complaints. Completes site visits when needed. Identifies and reports compliance issues in accordance with Plan policy and procedure. Works with all departments to develop and execute strategies for optimally managing medical costs. Performs other duties and projects as assigned.