LTSS Provider Relations Account Manager- Dayton & Cincinnati Metro

The LTSS Provider Relations Account Manager is responsible for working in a highly matrixed organization and influencing internal stakeholder relationships. This role will engage with LTSS and HCBS providers to build, manage and maintain relationships, with a strong focus on operational efficiencies, proactive engagement, and reduced burden which all leads to retention of provider relationships and improving member access to care.

• Own the relationship with LTSS and HCBS providers with a proactive focus on overall provider satisfaction and retention
• Develop, maintain, and enhance relationships with key stakeholders including relevant provider associations.
• Act as a liaison and SME to providers and operations for the LTSS/HCBS provider network
• Work as community partner to assist LTSS/HCBS providers; develop education and establishing a proactive process for these providers.
• Work in collaboration with Operations and other internal stakeholders on provider issues including researching providers claim issues and provide a professional and comprehensive response to providers
• Work with leadership team to define deliverables and timelines
• Improve Electronic Visit Verification compliance rates for provider network
• Perform virtual and in-person initial onboarding and ongoing education to provider network.
• Prepare and lead internal and external meetings with key stakeholders
• Assist with the implementation of strategy on independent provider network
• SME for Waiver services for internal and external stakeholders
• Collaborate with Care Management, Incident Management and SIU to ensure providers are educated on billing practices.
• Provide education to internal and external partners on LTSS and HCBS services, billing, and portal support
• Responsible for understanding and educating providers on regulation changes
• Collaborate with leadership to ensure initiatives are properly managed
• Produce detailed reports, executive summaries, and business decision documents
• Provide clarification/verification for all levels regarding status/details
• May support other lines of business as needed
• Perform any other job duties as requested

• Bachelor’s degree in project management, Business Administration, or other related field, or equivalent years of relevant work experience required
• A minimum of three (3) years of relevant account management, claims, operational and technical or business work experience is required.
• A minimum of two (2) years of relevant Provider Relations experience supporting LTSS and HCBS experience is required.
• Knowledge of Medicaid, Medicare, LTSS, and HCBS and is required
• Experience translating business and contractual requirements is required
• Experience with Facets and other operational systems preferred
• Accreditation experience preferred

• Proficient in Microsoft Office tools, including Project, Word, and Excel
• Advanced troubleshooting, critical thinking, and problem-solving capabilities
• Proven ability to effectively interact with all levels of management within the organization
• Flexibility during organizational and/or business changes
• Demonstrate excellent analysis and collaboration skills
• Demonstrate sense of urgency
• Ability to effectively and efficiently work within a team
• Exceptional written and verbal communication skills
• Strong interpersonal and relationship building skills
• Ability to work independently and within a team environment
• Ability to multi-task and prioritize work to meet project deadlines
• Critical listening and thinking skills
• Time management skills
• Customer service oriented
• Decision making/problem solving skills

• Employment in this position is conditional pending successful clearance of a driver’s license…