Develop and execute ongoing account management and service strategy to meet corporate strategic / financial objectives.
Serve as main point of contact for the provider and coordinate all Premera interactions with assigned provider accounts.
Develop and maintain effective provider networks (standard and custom), often with complex payment methodologies. Participate in payment and delivery systems innovation initiatives.
Lead negotiation and implementation of complex or custom provider contracts.
Complete negotiations within preplanned rate targets, meet timelines, ensure the established implementation period and perform implementation audits for accuracy of assigned accounts.
Collaborate with Healthcare Economics in rate development and proposal analysis.
Establish and lead a multi-disciplinary team to provide operationally excellent service and support to assigned accounts.
Consult and educate assigned accounts and internal stakeholders, providing industry and cross account expertise. Create provider specific and public presentations.
Proactively communicate with Provider Strategy & Solutions (PS&S) leadership and internal stakeholders on account status to facilitate proper internal support of account management efforts to ensure that the resulting final contract supports Premera's operational and strategic goals.
Engage providers to promote the concept and understanding of patient engagement adherence, cost savings preventative programs
Other duties and projects as assigned.
Requirements
Bachelor's degree or four (4) years of experience in a provider or payer environment. (Required)
Four (4) years of experience in payer or provider contracting and managing provider relationships in health care or insurance industry to include: Two (2) years of experience negotiating contracts. (Required)
Working knowledge of Health Insurance Portability and Accountability Act (HIPAA), the National Committee for Quality Assurance (NCQA), government health care programs, and risk coding.
Knowledge of network development and provider/vendor network recruitment.
Knowledge of provider community and market anomalies.
Demonstrated ability to effectively manage complex contract negotiations.
Demonstrated ability to develop and execute strategy.
Strong experience and expertise in Provider Relations.
Independent work style, self-motivated, with ability to lead with minimal direction.
Demonstrated successful verbal and written communication skills including ability to develop and deliver public presentations, training, meeting facilitation, and broker presentations.
Strong analytical skills and problem-solving skills.
Proven ability to lead and direct teams addressing complex issues.
Strong interpersonal skills coupled with the ability to foster positive working relationships.
Strong organizational, planning and administrative skills.
Ability to work under pressu
Benefits
Health insuranceVision insurance
Additional Information
Workforce Classification:
Hybrid
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About the role of the Provider Network Executive III
The Provider Network Executive III (PNE III) develops and maintains effective relationships with a variety of Premera's key custom provider accounts to achieve Premera's operational and strategic goals, product development strategies, and continuity of Premera's vision and values. In this highly visible role, the PNE III is responsible for the negotiation and management of Premera's strategic provider relationships across the state of Washington. Success in this position is essential to support Premera's broader strategy, including the successful implementation of new products through effective provider engagement and negotiation to ensure alignment, support and adoption.
Premera · Mountlake Terrace, WA