Senior Provider Relations Advocate - Northern Indiana

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This position functions as a subject matter expert in Client Service operations. This position strives to bring consistency and experience to existing Client Services Account Managers in the local market by analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning. This position will organize, and assist assigned provider groups and/or financial pools, as well as fellow account managers, in achieving short and long term operational/strategic business goals/ by developing, enhancing, and maintaining operational information and models. They also develop and implement, in conjunction with the local Client Services Associate Director and/or Director, effective/strategic business solutions through research and analysis of data and business processes. The Senior Account Manager will develop and sustain a solid day-to-day relationship with stakeholders, the providers, and office staff to effectively implement business solutions developed by the Optum leadership team. The Senior Account Manager is accountable for overall performance and profitability for their assigned provider groups and/or financial pools.

Essential Job Functions

• Analyze risk pool and/or provider group performance to determine areas of focus or improvement opportunities, to include performing analysis of financial statements and other metric-related report to determine areas of focus or improvement opportunities
• Develops strategies and create action plans that align provider pools and groups with company initiatives, goals (revenue and expense) and quality outcomes
• Drive processes and improvement initiatives that directly impact revenue, HEDIS/STAR measures and quality metrics, coding and documentation process and educational improvements
• Use and analyze data to identify trends, patterns and opportunities for the business and clients, and collaborating and/or participating in discussions with colleagues and business partners to identify potential root cause of issues
• Collaborates with internal clinical services teams, alongside Client Services leaders, to monitor utilization trends and risk pools to assist with developing strategic plans to improve performance
• Assists provider groups with investigating standard and non-standard requests and problems, to include claims and member support services
• Maintains effective support services by collaborating effectively with the Director of Client Services, Regional Medical Director, Clinical Services team, Operations, and other corporate departments
• Demonstrate understanding of providers' business goals and strategies to facilitate the analysis and resolution of their issues
• Performs all other related duties as assigned

Primary Responsibilities:

• Solid analytical skills required to support, compile, and report key information
  
• Drive processes and technology improvement initiatives that directly impact Revenue, HEDIS/STAR measures and Quality Metrics, using standard project methodology (requirements, design, test, etc.)
  
• Use data to identify trends, patterns and opportunities for the business and clients. Develop business strategies in line with company strategic initiatives
  
• Engage provider staff and providers in analysis and evaluation of functional models and process improvements; identify dependencies and priorities
  
• Evaluate and drive processes, provider relationships and implementation plans
  
• Produce, publish, and distribute scheduled and ad-hoc client and operational reports relating to the development and performance of products
  
• Collaborate with other Client Services leads to foster teamwork and build consistency throughout the market
  
• Serves as a liaison to the health plan and all customers
  
• Requires solid presentation skills, problem solving and ability to manage conflict and identify resolutions quickly
  
• Have the ability to communicate well with physicians, staff, and internal departments
  

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Years of post-high school education can be substituted/is equivalent to years of experience

Required Qualifications:

• 5+ years of experience in a related medical field or health plan setting (network management, contracting and/or recruitment, or provider relations)
• Solid working knowledge of Medicare health care operations including HEDIS, CMS reimbursement models, and Medicare Advantage
• Knowledge of state and federal laws relating to Medicare
• Proficiency in Microsoft Word, Excel, and PowerPoint
• Proven exceptional interpersonal skills with ability to interface effectively internally with all levels of staff and externally with a wide range of people including physicians, office staff, hospital executives, medical groups, IPA's, the press, and community organizations
• Proven solid business acumen, analytical, critical thinking, and persuasion skills
• Proven solid verbal and written communication skills
• Proven ability to develop long-term positive working relationships
• Proven ability to communicate and facilitate strategic meetings with groups of all sizes
• Proven ability to work independently, use good judgment and decision-making process
• Proven ability to conduct performance evaluation to identify performance measures or indicators and the actions needed to improve or correct performance, relative to the goals
• Proven ability to resolve complete problems and evaluate options to implement solutions
• Proven ability to adopt quickly to change in an ever-changing environment
• Proven ability and willingness to travel, both locally and non-locally, as determined by business need

Preferred Qualifications:

• 5+ years of in a healthcare related field
• 3+ years of healthcare management experience
• Proven ability to function as a mentor to others

Physical & Mental Requirements:

• Ability to lift up to 25 pounds
• Ability to push or pull heavy objects using up to 25pounds of force
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to properly drive and operate a company vehicle
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving