Provider Network Account Executive I

Duties:
Under the general direction of the Manager Provider Network Management, the Provider Network Management Representative is responsible for the administrative and operational oversight of assigned accounts within assigned territory.
Manages day-to-day client contacts and requests of assigned accounts and elevates issues to the next level as appropriate.
Manages client relationships to ensure client's needs are met.
Prioritizes client requests as appropriate.
Oversees and ensures timely resolution of client issues, including eligibility, network concerns, ID card issues and other related claims processing issues.
Ensures timely delivery of client monthly/quarterly reports.
Interfaces and manages operational issues with ACLA functional areas.
Develops ACLA performance improvement plans when necessary, and monitors performance guarantees.
Manages contract compliance with each client and reports non-compliance to manager.
Investigates and attempts to resolve all customer complaints and elevates unresolved issues as necessary.
Drafts and updates ACLA client policies on a routine basis as necessary.
Participates in the planning and execution of quarterly client visits.
Proactively develops an understanding of existing client's key issues and business requirements and works with internal team to meet business requirements.
Maintains current knowledge base of program services, policies and procedures regularly reviewing and reacting to policy updates and departmental procedures.
Performs other related duties and projects as assigned.
Attends required training on an annual basis.
Supports and carries out the AmeriHealth Caritas Family of Companies (ACFC) Mission & Values.
Adheres to ACFC policies and procedures.
Creates and supports an environment which fosters teamwork, cooperation, respect and diversity.
Establishes and maintains positive communication and professional demeanor with ACFC employees and clients at all times.
Demonstrates and supports commitment to corporate goals and objectives.
Adheres to ACFC policies and procedures. Supports and carries out the Mercy Mission & Values.
Action oriented.
Responsive to the needs and expectations of internal/external customers.
Ability to prioritize activities and implement actions to ensure customer needs are met.
Excellent interpersonal skills.
Thorough knowledge of administrative and operational pharmacy processes.
Demonstrated ability to effectively work with and manage customer teams.
Computer skills eligibility system, Word, PowerPoint, Excel.
Very good oral and written communication skills.
Very good listening skills.
Excellent problem solving skills.
Ability to work independently.
Ability to effectively articulate customer needs as well as manage customer expectations.
Working knowledge of medical terminology, pharmaceutical terminology and practices.
Proven ability to write technical articles, and draft presentation documents.
Ability to handle multiple priorities and projects independently.
Ability to extrapolate data and present research results.

Knowledge and understanding of drug benefit design

Skills:
Minimum 2 years Managed Care or PBM experience

Education:
Bachelor's Degree or equivalent work experience.