Account Manager #65441
To view the complete job description and apply, please visit: https://northernlighthealth.org/Careers/Position/65441/Account%20Manager
The Account Manager serves as a liaison between Beacon Direct and its customers. This involves maintaining positive, professional relationships with employers, members/dependents, participating network providers and vendors. This position works closely with the Senior Leadership team in managing new and existing client account relationships, while maintaining a high level of client service and satisfaction.
The Account Manager must be strong in analytics and have well-developed written and verbal communication skills. The Account Manager must be able to work independently with minimal oversight and should possess personal computer proficiency, a commitment to high quality customer service and the ability to manage multiple projects and priorities. The Account Manager must have a high degree of honesty and professionalism and possess interpersonal skills necessary to develop and foster relationships with various levels of management.
Reports to: Director of Account Services
Understands and supports all lines of business within Beacon Direct LLC.
Exercise a matrix management approach to coordinate functional areas across Beacon Health and Northern Light Health to direct, manage and support Beacon Direct lines of business.
Responsible for an effective relationship with the diverse teams involved in delivering high quality services to employers and members – including, medical management, network management and credentialing, compliance and legal, marketing and communications, finance and budgeting and other relevant functions
Works directly with Beacon Health Senior Leadership and Sales Representatives to assure that all aspects of account service run smoothly.
Responsible for resolving assigned member issues as assigned/instructed by Director of Account Services.
Possesses a working knowledge of health plan benefits provisions for assigned customers, physician/hospital/ancillary reimbursement methodologies, provider contracts, and provider network capacity.
Following up on high-visibility claims as requested by the Director of Account Services.
Reviewing operations & network performance reports (e.g., % clean claims, average time to first claims, unpaid aging, out of network usage, call center statistics, % of auto adjudicated claims, average days to pay, etc) for trends and escalating as appropriate.
Monitor health plan call center and member customer service for accuracy and appropriate resolution. Escalate recommendations for improvement to the Director of Account Services.
Assist the Director of Account Services with SPD changes, reviewing denials and researching appeals.
Demonstrates ability to diagnose and fix root cause drivers of service problems.
Participates in educational opportunities (e.g., benefit fairs and open enrollment sessions) as requested by Beacon Direct customers.
Reviews, and maintains awareness of policy & procedures updates and benefit information to adequately communicate with members.
Monitor, triage and resolve the complaint ticketing que and trend issues to report to leadership.
Reviews and develops ways to streamline and simplify internal processes as necessary to reduce turnaround time and improve data quality. Initiates process improvement projects resulting from operational concerns.
Performs other duties as required or assigned.
SKILLS AND ABILILITIES:
Ambitious individual focused on understanding and meeting their customer needs by leveraging insights and data to serve as a trusted partner and to deliver aligned solutions.
Demonstrates the ability to build and maintain strong member and client relationships with both internal and external customers.
Demonstrates excellent oral, written and verbal communication focusing on professionalism, conflict resolution and positive reinforcement.
Demonstrates strong analytical, problem solving and organizational skills and the ability to handle complex issues.
Demonstrates the ability to work both independently and as a team member.
Must be flexible with the ability to adapt to changes quickly and think conceptually.
Proficient in MS Office including Excel and Power Point.
EDUCATION AND/OR EXPERIENCE:
Bachelor's degree in a healthcare/insurance, business, finance or related field required.
5-7 years of healthcare reimbursement experience required.
Experience in reviewing and validating the accuracy of medical claims and payment preferred.
Thorough knowledge of health plan operations including claims handling, procedures, agency management systems and applicable insurance laws/codes a plus.
ICD-10 and/or CPT coding experience a plus.
Customer service experience strongly preferred.