Senior Provider Network Account Executive

Senior Provider Account Executive

The primary responsibility of Senior Provider Account Executive is to develop strong relationships with providers to drive performance specifically as it relates to core providers who are on risk-based or cost sharing value-based care arrangements as well as large health system contracts.

Responsibilities:

• Supports network development and network management strategies.
• Assists the Leader with departmental activities related to provider satisfaction, education, and communication.
• Participates and implements Provider Network education programs and materials (both internal and provider targeted) and is assigned to train, mentor, and support new Account Executives.
• Manages hospital and physician network development and management; including joint operating committees (JOC) for identified groups, oversight of necessary quality review meetings with targeted providers and/or health systems.
• Builds, nurtures, and maintains positive working relationships between Plan and its contracted providers; including those that are most complex.
• Resolves Provider disputes in a timely and compliant manner.
• Responsible for a higher number of multiple practice locations and multi-specialty practices and multiple providers. Should also include hospital systems, contracted subcontractors (DME, Vision, etc.), and ancillary providers.
• Develops/implements/manages programs and projects that support/impact high dollar and high member provider groups.
• Performs site visits as needed.
• Oversees resolution of provider issues managed by other Provider Network support teams.
• Takes corrective actions required up to and including termination, following Plan policies and procedures.
• Operationalizes completed contracts with advanced complexity.
• Consults on value-based contracts, facilitates for success (JOCs, performance overview, etc.) with specific bonuses attached to performance improvement.
• Maintains and manages value-based contract requirements, including but not limited to; monitoring performance standards against VBC or State program requirements, working with key stakeholders and provide oversight on applicable data-sharing or report requirements.
• General operational knowledge related to provider satisfaction, education, and communication with a fundamental understanding of operational items such as claims, payment integrity, provider data, credentialing, appeals disputes, etc.
• Supports contracting for multiple product lines, including LTSS, Exchange, DSNP adequacy gaps (high complexity).
• Assists with recruiting providers based on identified network adequacy gaps (high complexity).
• Supports VBC negotiations; leads in VBC relationships; may lead negotiations.

Education/Experience:

• Associate's Degree required or 5+ years as an Account Executive.
• Bachelor's Degree preferred.
• Preferred Experience Level (if different from minimum required): Seven years' experience if no bachelor's degree.
• Five (5) or more years strong communication skills, financial acumen, ability to have difficult conversations.

Compensation:

The anticipated hiring range for this position is $82,500 to $112,500 annually. Actual compensation will be determined based on factors including relevant experience, education, certifications, specialized skills, and internal equity.

At Enlightened, we pride ourselves on offering a comprehensive and industry-competitive benefits package to our full-time employees. Our benefits include:

• Medical/Dental/Vision Insurance with Health Savings Accounts (HSA)
• Flexible Spending Accounts (FSA)
• 401(k) Retirement Plan
• Paid Holidays, Vacation, & Sick Leave
• Professional Training & Development Reimbursement

Please note, these benefits are available exclusively to full-time employees of Enlightened.

Equal Opportunity Statement:

Enlightened is proud to be an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, disability, or any other federal, state, or local protected class.