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National Account Manager Resume Example

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NATIONAL ACCOUNT MANAGER
Professional Summary

An innovative, healthcare professional with 14 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 presentations to administrators, physicians, office staff,and employees.

Skills
  • Planning and development 
  • Process Improvement 
  • Project Management 
  • Customer needs assessment
  • Client Relations Management 
  • Medicaid Management Information Systems
  • Microsoft Office Suite expert
  • Meeting Facilitation 
  • Strategic planning
  • Customer rapport
  • Territory management
  • Contract Negotation 
  • Oral and written communication
  • Medicaid expertise
  • Vendor Relations
  • SharePoint
Work History
National Account Manager, 11/2017 to Current
Company Name – City, State
  • 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
Company Name – City, State
  • 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
Company Name – City, State
  • 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
Company Name – 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 the 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 and 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 06/2021
American Intercontinental University - City
Bachelor of Arts: Communications Studies, 2016
Ashford University - State
High School Diploma: 1993
Stanton College Preparatory School High School - City, State
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Resume Overview

School Attended

  • American Intercontinental University
  • Ashford University
  • Stanton College Preparatory School High School

Job Titles Held:

  • National Account Manager
  • Provider Relations Manager
  • Project Manager II
  • Senior Communications Specialist

Degrees

  • MBA : Expected in 06/2021
    Bachelor of Arts : Communications Studies , 2016
    High School Diploma : 1993

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