Account Manager,Managed Care

Pediatric Associates was founded in Hollywood, FL in 1955. The same clinician-led, evidence-based, medical home passion is a unifying driver for those who join Pediatric Associates Family of Companies. The Pediatric Associates Family of Companies is a growing team of Pediatricians and Pediatric Care Teammates who are excited to be part of the first nationwide Pediatric Primary Care Medical Home. We further our uniqueness by ensuring the clinician voice is leading our medical home innovations.

Remote Opporutnity

Primary Functions

Develops and maintains strong payor relationships, serves as primary point of contact and payor liaison. Maintains an understanding of contractual arrangements.

Ensures all payor issues are addressed at monthly/quarterly meetings.

Resolves and responds to payor communications/requests, addresses payor issues including member complaints, and evaluates and resolves payor compliance issues.

Responsible for payor operations including maintaining contract data bases and fee schedule.

Monitors, tracks, and evaluates incentive programs and assists in the resolution of program performance and payment issues.

Researches, escalates, and addresses contract loading and payment issues involving Capitation, Gainshare/Risk, Pay for Performance, and other Incentive arrangements.

Supports growth initiatives by conducting due diligence, managing the payor notification process, and ensuring timely loading and issue resolution for all acquisitions.

Maintains tracking tools/systems, and processes for contract implementation, evaluation, and ongoing performance.

Maintains a system of communication to collaborate with internal departments and management.

Identifies payor trends and anticipate issues which may impact the organization.

QUALIFICATIONS

EDUCATION: Minimum Bachelor's Degree required. Associates Degree plus minimum of 5 years related experience may substitute for Bachelor's Degree requirement.

EXPERIENCE: Minimum 3 years of Managed Care or Healthcare experience required including experience with payors and large groups.

KNOWLEDGE, SKILLS AND ABILITIES

• Managed Care and provider relations experience and knowledge
• Knowledge of Medicaid, payor reimbursement methodologies, and Value Based Care
• Ability to analyze and interpret financial data
• Knowledge of credentialing and claims processes
• Advanced Microsoft Office skills
• Excellent oral and written communication skills
• Strong interpersonal skills
• Effective planning and organizational skills, critical thinker and action oriented

TYPICAL WORKING CONDITIONS

• Non-patient facing
• May be either full time remote/telework or rotate working in the office and remote/telework
• If remote, this job must be U.S. based
• Indoor Work
• Operating Computer
• Reach Outward; Reach above shoulder
• Standing; Sitting; Traveling
• Walking; Bending
• Ability to wear Personal Protective Equipment (PPE)

OTHER PHYSICAL REQUIREMENTS

• Vision
• Sense of sound
• Sense of touch
• Manual dexterity

PERFORMANCE REQUIREMENTS

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.

The Pediatric Associates Family of Companies an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.