Job Summary:

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.

Essential Functions:

• 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
• Perform any other job duties as requested

Education and Experience:

• 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, HCBS, and Ohio Home Care Waiver experience is required.
• Knowledge of Medicaid, Medicare, MyCare, LTSS, HCBS, and Ohio Home Care Waiver is required.
• Experience translating business and contractual requirements is required
• Experience with Facets and other operational systems preferred
• Accreditation experience preferred

Competencies, Knowledge and Skills:

• 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

Licensure and Certification:

• Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if you have started employment in this position, your employment in this position will be terminated
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process

Working Conditions:

• Mobile Worker: This is a mobile position, meaning that regular travel to different work locations is essential. Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time.
• Reside in the state of Ohio.
• May be required to travel greater than 50% of time to perform work duties. A valid driver’s license, car, and insurance are necessary for work related travel
• Required to use general office equipment, such as a telephone, photocopier, fax machine, and personal computer
• Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our member and may refer members to other CareSource resources

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.