External Medical Services Jobs


Provider Experience Account Manager Rockville MD Rockville, MD


The Provider Experience Account Manager develops, manages and sustains relationships between KP-MAS (Health Plan and MAPMG) and a select group of assigned providers to ensure satisfaction, problem resolution and personal attention. The primary interaction will be with external facilities and physicians but could also involve management and frontline Health Care workers. Plan, develop and execute provider satisfaction strategies.

Essential Responsibilities:
- Responsible for the provider experience for a select group of providers once the contract is executed.
- Develops strategic relationships with select providers.
- Monitors provider contracts to ensure contract commitments are met.
- Acts as a Liaison between the provider and claims processing units.
- Understands and provides input to KP-MAS strategies as it relates to network development.
- Develops and manages provider projects, including defining deliverables and key milestones.
- Assists in the development of provider satisfaction success measures.
- Identifies needed resources for provider issues; assists in defining and assigning major project roles.
- Identifies barriers/constraints/risks to providers and provides recommendations to mitigate.
- Excellent ability to work effectively and creatively within the organization to resolve problems.
- Participates in Joint Operating Committees.
- Participates in both clinical and operational meetings as needed.
- Facilitates improvement efforts, and develops implementation recommendations.
- Facilitates collaboration with diverse groups and individuals to influence provider strategic planning and execution.
- Develops, maintains and effectively manages internal relationships at all levels across the organization.
- Acts as primary contact for external providers and their office staff.
- Identifies provider trends, conducts market intelligence to understand key issues and reports to leadership.
- Other duties as assigned.


Basic Qualifications:
- Minimum of five (5) years of health care experience with at least three of those years in one of the following areas: provider relations, account management, operations management, contract design/negotiation, or claims. Education

- Bachelor's degree or four (4) years of directly related experience required.
- High School Diploma or General Education Development (GED). License, Certification, Registration

- N/A

Additional Requirements:

- Exceptional oral and written communication skills
- Excellent presentation skills
- Exceptional influencing and partnering skills at all organizational levels required
- In-depth knowledge of health care issues and a variety of facility, hospital, or physician office procedures, concepts and practices
- Strong knowledge of health care industry and financing mechanisms
- Strong knowledge of claim processing, adjudication and payment methodologies
- Strong knowledge of various coding and claims processing systems and approaches.

Preferred Qualifications:

- Master's degree.

Primary Location: Maryland,Rockville,Rockville Regional Offices 2101 E. Jefferson St.

Scheduled Hours (1-40): 40

Shift: Day

Working Days: Mon-Fri

Schedule: Full-time

Job Type: Standard

Employee Status: Regular

Employee Group: Salaried, Non-Union, Exempt

Job Level: Individual Contributor

Job: External Medical Services

Public Department Name: Provider Experience

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

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