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Health Management Systems, Inc. Sr. Carrier Account Manager in Irving, Texas

HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.

We are seeking a talented individual for a Sr. Carrier Account Manager who manages and is responsible for significant carrier relationships with carriers in support of the successful delivery of HMS services to the largest, most complex commercial carriers. Manages budget and revenue expectations and the ongoing negotiations with assigned carriers. Oversees all assigned accounts and revenue expectations to ensure carrier objectives are met.

Essential Responsibilities:

  • Oversees assigned accounts and ensures that we continue to maintain a strong working relationship with key carrier decision making stakeholders.

  • Prepares, monitors, and manages budget and revenue expectations for all assigned carriers.

  • Supports collaboration between CR team and all other HMS departments.

  • Reports to management on progress toward strategic carrier growth and opportunities.

  • Presents business reviews on progress against team goals/objectives and strategic plans.

  • present business reviews against their goals/objectives and strategic plans

  • Reviews and ensures increased yield from assigned carriers and steady pay rates are met.

  • Works with CR team to develop materials for carrier presentations.

  • Communicates/interfaces regularly with carriers.

  • Oversees platform enhancements and billing file fixes/updates.

  • Resolves and reworks any denials that can be resubmitted.

  • Determines best course of action for all unprocessed claims.

  • Responsible for building relationships with the top revenue generating commercial insurance carriers and internal staff to ensure carrier objectives are met.

  • Manages reporting and forecasts for carrier portfolio, including presenting trends, forecast analysis and planning to HMS management and carrier management teams.

  • Performs analytical work including data analysis of carrier performance. Identifies trends and issues, evaluates and presents solutions for issues identified. This includes working with programming to develop technical solutions that improve financial performance of carriers. Analysis on carriers includes but is not limited to: analysis of top carrier, procedure codes, bill types, and claims types. The building of technical solutions requires working with Programming, IT, and Cycle Operations to ensure developed solutions meet and exceed transformation expectations.

  • Designs and develops reports and presentations as well as presenting results at carrier meetings and for internal clients.

  • Identifies and continually seeks new sources of recoveries. Recommends and presents strategies to increase recoveries or new revenue opportunities.

  • Coordinates, conducts and communicates/interfaces regularly with HMS’s largest carrier relationships.

  • Manages carrier billing process and ensures cycles go out the door, are accepted by carriers, and lastly follows claims through carrier payment processes through the receipt of remittances. Performs data analysis on any underperforming results, recommends corrective action, or takes action when results are less than anticipated.

  • Is focused on improving cost of processing with each assigned carrier. Ensuring that we are continually removing claims that carriers would not reimburse, as well as working towards ensuring all transactions are performed electronically.

  • Identifies carrier processing issues and provides solutions to maximize recoveries and reduce operational expense.

  • Interacts routinely with both internal constituents and external carrier contacts.

Non-Essential Responsibilities:

  • Performs other functions as assigned

Knowledge, Skills and Abilities:

  • Ability to be careful and thorough about detail

  • Ability to multi-task and to meet deadlines

  • Ability to perform data analysis to benchmark results against plan and use logic and process to address work-related issues and problems

  • Ability to build effective relationships demonstrating strong interpersonal skills

  • Exceptional customer service skills

  • Ability to work proficiently with Microsoft Excel, Word, Access, PowerPoint, SQL or Micro Strategies and company databases

  • Expertise with third party billing systems

  • Strong analytical and multi-tasking abilities

  • Ability to present to management level staff

  • Must have ability to travel up to 10% of the time to carrier locations for status meetings

  • Ability to negotiate and collaborate

  • Ability to manage expectations, resolve problems, and develop opportunities

  • Ability to manage projects

Work Conditions and Physical Demands:

  • Primarily sedentary work in a general office environment

  • Ability to communicate and exchange information

  • Ability to comprehend and interpret documents and data

  • Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)

  • Requires manual dexterity to use computer, telephone and peripherals

  • May be required to work extended hours for special business needs

  • May be required to travel at least 10% of time based on business needs

Minimum Education:

  • Bachelor’s degree required, Master’s degree preferred

Minimum Related Work Experience:

  • 6 years relevant experience in either health insurance, revenue cycle, account management with high level of compliance (i.e. Finance).

  • Experience developing strategic account relationships

Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

HMS is an Affirmative Action and Equal Opportunity Employer who offers a drug-free workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a disable veteran or veteran of the Vietnam era.

Title: Sr. Carrier Account Manager

Location: Texas-Irving

Requisition ID: 2100101Y

EEO/Minorities/Females/Protected Veterans/Disabled.