National Account Manager Resume Example
Love this resume?Build Your Own Now
NATIONAL ACCOUNT MANAGER
Professional Summary
An innovative, healthcare professional with 16 years of managed care experience in Account Management, Provider Relations, Project Management and Marketing. Strong background in building and managing client relations, claims analysis, investigating and resolving provider/member complaints, proactively identifying provider needs, conducting geo deficiencies reviews, delivering and facilitating presentations to C Suite executives, Hospital administrators, physicians, staff, and employees.
Skills
|
|
Work History
Provider Network Contractor/Consultant (Remote), 08/2021 to Current
Fleetcor – Covington , LA
Fleetcor – Covington , LA
- Prepare, analyze, and review network performance against required access standards.
- Negotiate and build a stable provider network that achieves objectives for unit cost performance and trend management
- Evaluate and negotiate contracts with healthcare providers in compliance with contract templates, reimbursement structure standards, and other key process controls.
- Establish and maintain relationships with healthcare providers and ensure the network composition includes an appropriate distribution of provider specialties.
- Provide explanations and interpretations for the provider network roster
National Account Manager, 11/2017 to 07/2021
Healthcare Partners – Magan Covina Main , CA
Healthcare Partners – Magan Covina Main , CA
- Account Management oversight services rendered to Health Plans Located in Georgia, Mississippi, Michigan, and Tennessee. 7 Health plans with various Lines of Business (Medicaid, Medicare MAPD, Medicare DSNP, MMP, and Ambetter). Product: Dental Benefits Manager and Vision Benefits Manager.
- Manage key Health Plan Accounts , client relationships, and complete Dental and Vision Dashboards for Health Plan by Line of Business
- Monthly Operations Meetings and Joint Operations Committee Meetings held with Health Plan Clients to review quarterly Dental and Vision performance for Lines of Business (Medicare, Medicaid, MMP, and Ambetter)
- Assist in the project management of all contract implementations and in the establishment of strong account relationships while ensuring a smooth transition of services for members.
- Provide education and training to Health Plan Clients regarding Benefits, Reporting issues, address State concerns and inquiries internally and externally
- When applicable - attend and complete scheduled site visits, ZOOM calls and Annual Vendor Delegation Meetings
- Act as liaison for Envolve and Health Plan and departments
- Coordinate with the Quality Improvement department for the tracking of complaints/concerns and ensure timely follow-up, including resolution with all appropriate operations and/or corporate staff.
- Collaborate with external Health Plan Partners to resolve complex issues related to member, provider, and state concerns. problems complaints identified by accounts and manage account issues to closure
- Translate ideas and client requests into actionable items for the operations, call center or product development team to enhance service delivery or new product offerings.
Provider Relations Manager, 05/2013 to 11/2017
Gilbane Building Company – Revere , MA
Gilbane Building Company – Revere , MA
- Manage day-to-day provider relations activities and provider relations department.
- Maintain production and quality standards Initiate and execute standard physician, ancillary, and home and community based service provider contracts.
- Coordinate all pre-contract activities with providers such as, site visits, credentialing, orientation to contractual requirements, etc.
- Maintain contracts and correspondence files in organized and accessible manner for all providers.
- Prepare and analyze information to evaluate the need for additional health plan providers.
- Manage and coordinate customized provider contracts.
- Continually improved knowledge, skills and performance based on feedback and self-identified professional developmental needs.
- Identified process improvements in the day-to-day functioning of the department.
- Routinely collaborated with department managers to correct problems and improve services.
- Strategically planned methods to achieve operational goals and targets.
Project Manager II, 05/2011 to 07/2013
Advisor Group – Myrtle Point , OR
Advisor Group – Myrtle Point , OR
- Oversight of Medical Management's Provider Incentive Program Tracking, creating and maintaining the Gantt chart Plan.
- Planning the quarterly visits for the provider groups that satisfactorily met the incentive goals, provide reports and discuss progress.
- Attend/facilitate all Delegated Vendor Oversight Departmental meetings, recorded minutes, track progress and follow-up with vendor issues.
- Ensure that all vendors/clients satisfy contractual goals and adhered to a tracking system to monitor performance standards.
- Facilitate and organize the Health Plan's bi-weekly operational meetings, facilitate, coordinate, and maintain a matrix of outstanding items and follow-up with the appropriate business owners prior to the next scheduled meeting.
- All items housed on company's Intranet (SharePoint).
- Routinely collaborated with other department managers to correct problems and improve services.
- Verified data integrity and accuracy.
- Compiled, validated and updated all required materials needed for Provider Incentive Meetings
- Responded to Provider and Delegated Vendor Requests via telephone and email.
- Analyzed departmental documents for Provider Incentive Meetings and report compiliation
- Produce Travel Iterariers for Provider Incentive Trips
- Conducted follow-up prior to meetings to ensure that all responses were reviewed and completed prior to meeting.
Senior Communications Specialist, 05/2006 to 05/2011
Peach State Health Plan – City , STATE
Peach State Health Plan – City , STATE
- Perform duties for development and coordination of written documents and communications activities.
- Plan, research, write, and edit articles for insertion in Provider and Member Newsletters, collaborating with the Corporate Director of Communications and Public Affairs to meet production deadlines.
- Responsible for compilation and updating of Provider Manual and Provider Directory.
- Primary contact for Provider and Member Web Site management at the healthplan level.
- Coordinate development and approval of all provider and member communication materials including letters, announcements, etc. to the Department of Community Health for the State of Georgia with the department of Community Health for the State of Georgia.
- Coordinate internal and external marketing efforts to promote special programs/events, including, but not limited to planning, writing, designing printed materials, events planning, and developing mailing lists.
- Assist health plan internal department's development of newsletters, flyers, and memos.
- Ensure and track the submittals and responses for all member and provider communications from the Department of Community Health.
- Supported the Vice President, and Directors of Member and Provider Services with daily operational functions.
- Introduced new mailing systems, vendors, and project initiatives to save money and meet budigetary goals.
- Implemented the Intranet/Share Point heath plan wide with the assistance of corporate IT. Each department had its own sharepoint page for departmental news, updates, and respository purposes
Education
MBA: Expected in 03/2022
American Intercontinental University - City
American Intercontinental University - City
Bachelor of Arts: Communications Studies, 09/2016
Ashford University - State
Ashford University - State
High School Diploma: 1993
Stanton College Preparatory School High School - City, State
Stanton College Preparatory School High School - City, State
DISCLAIMER
Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.
How this resume score could be improved?
Many factors go into creating a strong resume. Here are a few tweaks that could improve the score of this resume:
Resume Strength
- Completeness
- Word choice
- Measurable results
- Typos
Resume Overview
School Attended
- American Intercontinental University
- Ashford University
- Stanton College Preparatory School High School
Job Titles Held:
- Provider Network Contractor/Consultant (Remote)
- National Account Manager
- Provider Relations Manager
- Project Manager II
- Senior Communications Specialist
Degrees
- MBA : Expected in 03/2022
Bachelor of Arts : Communications Studies , 09/2016
High School Diploma : 1993
Similar Resumes
