Job ID# 10018714 – Posted 8/10/22 – Remote

The Account Manager III is responsible for identifying, contacting, and actively soliciting qualified providers and/or provider organizations; assuring the financial integrity of company is maintained through rate negotiation; and, ensuring contract requirements are adhered to, including language, terms, and reimbursement requirements.

The Account Manager III is responsible for the project management of all contract implementations and renegotiation functions, from pre-contracting to activation, according to pre-determined internal guidelines and financial standards, while ensuring a smooth transition of services for members.

Responsible for drafting contract clauses/addenda, review, and negotiating new contracts/amendments and other contracting related documents based on company contracting guidelines, parameters, and standards, including leadership strategy discussions; implementing contracts/amendments across company; and providing in-service orientation meetings with providers. Responsible for monitoring managed care contracts for renewals and expirations.

Acts the liaison between PNM and other internal Plan departments, as necessary, to resolve complex issues, and to effectively deliver accurate, timely, and appropriate information to their assigned accounts. Responsible for supporting the credentialing and re-credentialing process, investigation of member complaints, and assisting company in investigating any potential quality issues.

Monitors timely receipt of contractually-required reporting. Acquires and maintains a functional working knowledge of applicable systems like QNXT, Visual Cactus, and proprietary provider databases, and routinely relays information about additions, deletions, or changes to the company Provider Network Management (PNM) Provider Data Management department.

Researches and resolves contractual interpretation, operational and/or payment issues; researches and resolves incoming escalated provider inquiries within specified guidelines; educates providers on new protocols, policies, and procedures. Ensures provider database and documentation is up-to-date, accurate, and complete.

Maintains a complete understanding of company reports and metrics to evaluate the performance of assigned providers and/or provider organizations, and use the data to develop and implement methods to improve relationships with all providers. Responsible to assist in all corrective actions required, up to and including termination, following company policies and procedures, and applicable contractual and regulatory requirements.  Responsible for supporting the credentialing and re-credentialing process, investigation of member complaints, and assisting company in investigating any potential quality issues.

Serve as a communication link between provider accounts and company. Complete regularly scheduled meetings (site visits, or conference calls) with all accounts. Translate information exchange, ideas, requests and other inquiries into actionable items for improved contracting/relationship management and enhanced operational service delivery. Supporting all of the PNM departments (Oversight and Monitoring; Engagement and Strategy; Data Management; and, Operations). Supports all of the PNM groups; assists in the development and distribution of provider engagement material (trainings, notices, newsletters); assists in oversight and monitoring efforts; implements company provider strategies; and assists in improving the quality of provider data, as needed.

Minimum of 4 years of experience in contracting and/or regulatory analysis in managed care or healthcare industry.  

Bachelor’s Degree In lieu of degree, equivalent education and/or experience may be considered. 

Master’s Degree.

Please send your resume and any additional information to our recruitment team at recruitment@nexlogica.com