Purpose:

UPMC Health Plan is looking for a Provider Account Executive in the Southeast, PA area to join the team!  Candidates must be 
located in Philadelphia or surrounding counties to be considered. This is a full time work from home position that requires travel to provider sites in Philadelphia, Montgomery, Bucks, Delaware and Chester counties as well as occasional travel to a UPMC office. 

The Provider Account Executive will: manage relationships with Home and Community Based Service (HCBS) providers 
within the Southeast and surrounding area, provide education and support to assist Providers to improve quality of service, assist the provider in developing action plans, support claims/payment inquiries, and support ongoing provider education. Work with a broad spectrum of UPMC Health Plan personnel, network providers, and external resources to complete all tasks related to network management projects, goals and objectives.

Responsibilities:

Monitor ongoing provider performance and provide education to improve compliance and quality. Provide information on plan resources to assist. Meet with providers to review/update current information and review regulation compliance. Meet with providers to review/update current information and review regulation compliance. Identify, document and distribute best practice information. Manage special projects assigned by manager and department director. Meet deadlines and turnaround times set by manager and department director (these deadlines and turnaround times 
will, at times, require the employee to work until the project is completed, meaning extended daily work hours, extended 
work weeks, or both). Recruit, contract, orient new providers as needed/assigned. Assist Manager in coordination of staff development and Provider training.  Act as liaison between providers and key UPMC depts, ie; Service Coordination, Provider Monitoring, FWA, Claims, 
etc. Assist providers to resolve issues related to billing, authorizations, regulation compliance, etc. Ensure provider submission of acceptable compliance related Correction Plan