Network Account Manager Resume Samples

Description :

1. Challenged to maintain and build network of providers that provide critical health services for clients while ensuring affordable prices.
2. Clients included individual physicians, large physician groups and major hospital systems in Westchester and Suffolk county New York.
3. Strategically planned and motivated the team in compliance projects to meet department of health regulations in accordance with given timeframe.
4. Through researched of the market and client engagement managed cost increases below set company targets.
5. Reduced costs of specific high dollar physician contracts by as much as 60%.
6. Ensured that patients had the most up to date information for critical health care needs.
7. Built and maintained relationships with large physician groups and hospital systems that strengthened the business relationship between those clients and Aetna.

Experience

7-10 Years

Level

Management

Education

MBA

Description :

1. Executed strategic components of the HCD business plan for each market.
2. Coordinated with segment constituents on medical cost and membership growth and network fortification initiatives.
3. Communicated with external constituents to effectively engage the provider community and demonstrate the Aetna value proposition.
4. Negotiated contracts and other understandings on behalf of the company.
5. Managed medical cost drivers and executes specific medical cost initiatives to support financial and medical cost objectives.
6. Proactively identified new trends and products within Aetna and the industry and works to raise awareness throughout the organization in order to gain consensus on a course of action and ultimately drive to implementation.
7. Consistently monitored Aetna service capabilities to collaboratively ensure that provider constituent's needs are met.

Experience

5-7 Years

Level

Executive

Education

BS In Business Management

Description :

1. Progressive focused on high-end IT services and in most cases is the IT department for our clients.
2. Provided Inside Sales support, build and maintain client relationships and handle all aspects of account management for clients.
3. Consulted with management on project proposals to determine goals, time frame, funding limitations, procedures for accomplishing projects, staffing requirements and allotment of resources.
4. Position terminated due to financial/recession causes.
5. Expertised with technology sales and quoting.
6. Scheduled projects and repairs, as well as engineers with clients.
7. Sought to optimize provider interaction and provides recommendations based on balance of provider needs and Aetna's objectives.

Experience

5-7 Years

Level

Executive

Education

Master Of Science In Psychology

Description :

1. Physician recruited medical manager responsible for developing and maintaining relationships with physician and business leadership of key physician groups, ancillary providers, and delivery systems.
2. Interacted with large, high profile physician groups, IPAs, PHOs and hospital systems to resolve disputes and find solutions that are mutually beneficial for both providers and the organization.
3. Built strong relationships with providers and key contacts to support on-going negotiating efforts to finalize routine contracts and recruitment arrangements with providers.
4. Understood medical cost drivers and executed specific medical cost initiatives to support operational objectives.
5. Identified opportunities for process improvement and works cross-functionally within the organization to gain desired outcomes regarding provider service issues.
6. Monitored the ever-changing and competitive landscape of health care delivery and evaluates the potential to adopt and implement policies and procedures to keep Aetna at the lead or ahead of industry movements.
7. Executed organizational strategy at the market level to meet and exceed company goals and objectives working directly with physicians and office managers.

Experience

2-5 Years

Level

Executive

Education

High School Diploma

Description :

1. Negotiated and executed contracts for physicians, large physician groups, anesthesia groups, radiology groups and Ambulatory Surgery Centers.
2. Prepared departmental contracts for attorney and medical economics approval.
3. Solved escalated claim issues and policy complaints.
4. Assisted physicians and office staff by training them on Aetna's physician website, Navinet.
5. Conducted quarterly meetings with six Physician Hospital Organizations including University of Toledo Physicians, Promedica and Mercy Health.
6. Handled demographic updates and changes for regional providers.
7. Helped with the Medicare Collaboration team and helped implement Patient Centered Medical Homes.

Experience

2-5 Years

Level

Junior

Education

MSA In Project Management

Description :

1. Created, managed, maintained and negotiated hospital and physician contracts for a Fortune 500 Company.
2. Responsible for organizing and hosting monthly meetings with multiple groups.
3. Researched and resolved contract and system issues, work closely with service teams and Six Sigma teams to resolve computer system issues, escalate claim disputes, and maintain positive business relationships with providers.
4. Prepared settlement documents, amendments, contract renewals and Director's reports for external presentations.
5. Managed contract approval process to meet/exceed business requirements and company initiatives.
6. Provided individual training to newly hired staff members, team training to other business segments, external customers, clients and national team leads throughout organization.
7. Demonstrated fifteen years experience prioritizing conflict demands from multiple business and internal clients in a fast paced work environment.

Experience

2-5 Years

Level

Executive

Education

MS

Description :

1. Recruited physicians and other providers using telephone, mailing and face to face meetings.
2. Monitored application process from beginning to end assuring all documentation is received, current and legible before submitting to Credentialling Coordinator.
3. Handled operational telephone inquiries from providers and front office staff.
4. Performed in-service training with physician and other provider front office staff/administrative staff to review Alpha Care operations.
5. Monitored provider complaint seeking trends and areas to improve AlphaCare policies.
6. Handled grievances from providers and from members when providers are involved.
7. Responsible for managing all primary care physicians in my assigned territory including IPA physicians.

Experience

7-10 Years

Level

Management

Education

BS

Description :

1. Recruited ancillary facilities including ambulatory surgery centers, stone centers, endoscopy centers and radiology facilities.
2. Researched and resolved assigned territories claim, operational issues and concerns.
3. Updated and maintained the integrity of United Healthcare's EPD (Enterprise Provider Database) system.
4. Educated and gave presentations about UnitedHealthcare Online and explain the benefits to the provider's office as well as cost efficiency for all.
5. Recruited doctors, ancillary, and surgery centers for startup network in Philadelphia Market.
6. Recruited ancillary providers for Pennsylvania market, e.g. MRI facilities, surgery centers, DME providers and hospital based physicians.
7. Responsible for educating all provider specialities about the product lines of business which includes Medicare, MLTC and the FIDA.

Experience

10+ Years

Level

Senior

Education

M.B.A.

Description :

1. Achieved quota in first month of employment NETWORK ACCOUNT MANAGER; SWITCH and DATA FACILITIES CO., LLC.
2. Responsible for connectivity for nearly 50% of the entire Company's facilities.
3. Educated providers of known system issues and industry changes.
4. Responsible for developing and maintaining relationships with physician and business leadership of key physician groups, ancillary providers, and delivery systems.
5. Served as the primary point of contact for over 600 provider accounts in the Nassau County area.
6. Provided Education/Training in regards to company-wide Initiatives, new products, incentives and regulatory standards.
7. Worked with different depts.

Experience

2-5 Years

Level

Executive

Education

BS In Business Management

Description :

1. Responsible for developing and maintaining positive relationships with providers and developing strategies for recruitment and contracting.
2. Reviewed, analyzed and processed non-complex grievances and appeals in accordance with external accreditation and regulatory requirements, internal policies.
3. Utilized guidelines and review tools to conduct extensive research and analyze the grievance and appeal issues with pertinent claims and medical records to approve or summarize and route to the medical director for review.
4. Identified and analyzed claims adjudication for payment and appropriateness of service and provided instruction and recommendations.
5. Facilitated seminars to train and support providers in both new and current procedures.
6. Reviewed contracts for compliance and reimbursement; maintained strong business relationships with providers to include analysis and investigation of claim denials and/or reimbursement rates.
7. Responsible for negotiating new Medicaid contracts, amendments, and renewing contracts in a highly competitive environment, including hospitals, IPAs, medical groups, and individual providers.

Experience

10+ Years

Level

Senior

Education

Master's In Business Management