Mass General Brigham Health Plan
Sr. Provider Network Account Executive, hybrid
Mass General Brigham Health Plan, Somerville, Massachusetts, us, 02145
As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community by leading innovation across our system. Founded by Brigham and Women’s Hospital and Massachusetts General Hospital, Mass General Brigham supports a complete continuum of care including community and specialty hospitals, a managed care organization, a physician network, community health centers, home care and other health-related entities. Several of our hospitals are teaching affiliates of Harvard Medical School, and our system is a national leader in biomedical research.We’re focused on a people-first culture for our system’s patients and our professional family. That’s why we provide our employees with more ways to achieve their potential. Mass General Brigham is committed to aligning our employees’ personal aspirations with projects that match their capabilities and creating a culture that empowers our managers to become trusted mentors. We support each member of our team to own their personal development—and we recognize success at every step.Our employees use the Mass General Brigham values to govern decisions, actions and behaviors. These values guide how we get our work done: Patients, Affordability, Accountability & Service Commitment, Decisiveness, Innovation & Thoughtful Risk; and how we treat each other: Diversity & Inclusion, Integrity & Respect, Learning, Continuous Improvement & Personal Growth, Teamwork & Collaboration.Position Overview
Reporting to the Regional Provider Relations Manager, the Senior Provider Network Account Executive is responsible for managing the relationships of a large territory of complex provider organizations and key constituents. They are responsible for the relationship management, provider education and engagement, and informing the organization of the provider perspective.Essential Functions
Relationship Building & Engagement
Demonstrate relationship management, instill credibility and trust, and influence through collaboration.Create effective communications; identifying appropriate message content, deliver clear verbal and written communications.Execute and support the development of engagement strategies within territory.Maintain effective working relationships with provider community within identified region.Understand and communicate community-related issues affecting provider-Mass General Brigham Health Plan relationships.Work collaboratively with the Provider Education & Training Manager to develop educational materials and resources to support territory.Present educational and training materials to large provider audiences (100+).Proactively engage providers identifying educational opportunities that decrease administrative burden, ensure provider compliance to contract terms, and enhance performance.Understand relationships and referral patterns within territory, contract terms, and reimbursement methodologies.Attend and represent Mass General Brigham Health Plan at provider network events and functions.Provider Management & Complex Problem Solving
Work directly with Contract Managers to support the overall contract management and maintenance as it relates to relationship management.Analyze reports and data and make recommendations or decisions to add value.Maintain operations management practices with large health care delivery systems, key constituents, and providers under complex contractual agreements.Develop provider specific project plans to aid in resolution of complex provider issues.Lead and facilitate meetings with cross-collaborative work groups consisting of internal and external constituents.Support roster management and ensure proper distribution to Provider Enrollment.Interdepartmental & Company Support
Provide consultative support to various initiatives and workgroups by sharing provider perspective.Conduct independent research on provider issues and bring to timely resolution.Collaborate with other departments and teams to create administrative simplifications.Working Conditions and Physical Effort
Must be willing to travel to provider offices located across New England.Must have valid license and method of transportation.Work is normally performed in a typical office work environment but may involve visits to hospitals and patient care settings.Minimum Requirements
Knowledge and Education Required:
Bachelor’s Degree or the equivalent combination of training and experience, plus 5 years of claims and provider networking experience.Strong knowledge of MassHealth is a plus.Experience Required
5 years of claims and provider networking experience.Skills/Competencies
Demonstrate Mass General Brigham Health Plan’s core brand principles of always listening, challenging conventions, and providing value.Strong aptitude for technology-based solutions.Respect the talent and unique contribution of every individual, and treat all people in a fair and equitable manner.Be accountable for delivering high-quality work. Act with a clear sense of ownership.Organizational Relationships/Scope
This position internally interacts with all levels of the organization from front line to Executive Leadership. Most frequently interacting with Directors, Managers, and Supervisors. Externally, this role interacts with various levels of provider/hospital administrative staff such as Directors of Managed Care, CFO’s, Billing Administrators and Office Managers.Primary Location
MA-Somerville-MGB Health Plan at Assembly RowWork Locations
MGB Health Plan at Assembly RowJob
Professional/ManagerialOrganization
Mass General Brigham Health PlanSchedule
Full-timeStandard Hours
40Shift
Day JobEmployee Status
RegularRecruiting Department
MGB Health Plan Provider RelationsJob Posting
Sep 12, 2023
#J-18808-Ljbffr
Reporting to the Regional Provider Relations Manager, the Senior Provider Network Account Executive is responsible for managing the relationships of a large territory of complex provider organizations and key constituents. They are responsible for the relationship management, provider education and engagement, and informing the organization of the provider perspective.Essential Functions
Relationship Building & Engagement
Demonstrate relationship management, instill credibility and trust, and influence through collaboration.Create effective communications; identifying appropriate message content, deliver clear verbal and written communications.Execute and support the development of engagement strategies within territory.Maintain effective working relationships with provider community within identified region.Understand and communicate community-related issues affecting provider-Mass General Brigham Health Plan relationships.Work collaboratively with the Provider Education & Training Manager to develop educational materials and resources to support territory.Present educational and training materials to large provider audiences (100+).Proactively engage providers identifying educational opportunities that decrease administrative burden, ensure provider compliance to contract terms, and enhance performance.Understand relationships and referral patterns within territory, contract terms, and reimbursement methodologies.Attend and represent Mass General Brigham Health Plan at provider network events and functions.Provider Management & Complex Problem Solving
Work directly with Contract Managers to support the overall contract management and maintenance as it relates to relationship management.Analyze reports and data and make recommendations or decisions to add value.Maintain operations management practices with large health care delivery systems, key constituents, and providers under complex contractual agreements.Develop provider specific project plans to aid in resolution of complex provider issues.Lead and facilitate meetings with cross-collaborative work groups consisting of internal and external constituents.Support roster management and ensure proper distribution to Provider Enrollment.Interdepartmental & Company Support
Provide consultative support to various initiatives and workgroups by sharing provider perspective.Conduct independent research on provider issues and bring to timely resolution.Collaborate with other departments and teams to create administrative simplifications.Working Conditions and Physical Effort
Must be willing to travel to provider offices located across New England.Must have valid license and method of transportation.Work is normally performed in a typical office work environment but may involve visits to hospitals and patient care settings.Minimum Requirements
Knowledge and Education Required:
Bachelor’s Degree or the equivalent combination of training and experience, plus 5 years of claims and provider networking experience.Strong knowledge of MassHealth is a plus.Experience Required
5 years of claims and provider networking experience.Skills/Competencies
Demonstrate Mass General Brigham Health Plan’s core brand principles of always listening, challenging conventions, and providing value.Strong aptitude for technology-based solutions.Respect the talent and unique contribution of every individual, and treat all people in a fair and equitable manner.Be accountable for delivering high-quality work. Act with a clear sense of ownership.Organizational Relationships/Scope
This position internally interacts with all levels of the organization from front line to Executive Leadership. Most frequently interacting with Directors, Managers, and Supervisors. Externally, this role interacts with various levels of provider/hospital administrative staff such as Directors of Managed Care, CFO’s, Billing Administrators and Office Managers.Primary Location
MA-Somerville-MGB Health Plan at Assembly RowWork Locations
MGB Health Plan at Assembly RowJob
Professional/ManagerialOrganization
Mass General Brigham Health PlanSchedule
Full-timeStandard Hours
40Shift
Day JobEmployee Status
RegularRecruiting Department
MGB Health Plan Provider RelationsJob Posting
Sep 12, 2023
#J-18808-Ljbffr