| Department: Outside Medical Services |
Job Status: Full Time |
| FLSA Status: Exempt |
Reports To: Director, Correctional Programs |
| Grade/Level: |
Amount of Travel Required: 0% |
| Work Schedule: |
Positions Supervised: None |
| Generally, 8:00 a.m. to 5:00 p.m. with some flexibility for occasional additional hours. |
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POSITION SUMMARY
The primary responsibility of the Account Manager I - OMN, is to support the day-to-day activities of the client and contracted medical providers by serving as the primary point of contact for operational support to these entities. This role is responsible for routine communication with clients regarding changes to the Provider Network, spending trends, claim inquiries, addressing operational issues, and researching payment information. The Account Manager is responsible for overall client satisfaction and is expected to proactively identify, resolve and/or appropriately escalate any service issues.
ESSENTIAL FUNCTIONS
Reasonable Accommodations Statement
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable Accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
Essential Functions Statement(s)
- Serve as Heritage's liaison with internal and external customers, to include: Heritage subcontractors, Customer Care Center (CCC), Contracting Department, and other internal functional units.
- Monitor and audit client authorization logs and documentation to stay within contract compliance requirements, ensure telephone, e-mail and faxes are addressed timely and forwarded to subcontractor(s) as appropriate, and ensure all inquiries are completed and closed.
- Monitor and audit content of information entered into Salesforce and other databases to ensure adequate documentation of events is recorded.
- Analyze data and create reports for clients
- Create and present quarterly business reviews to customers in person or via conference call.
- Coordinate implementation of new clients/customers/accounts - maintain a schedule of responsibilities within Salesforce
- Respond directly to inquiries from internal and external customers, orally or in writing, in a timely manner.
- Research, resolve and/or escalate program disputes.
- Communicate program information as needed to the Customer Care Center and assist that team in handling escalated client issues, or payment inquiries.
- Participate in staff meetings and conference calls.
- Communicate client changes and updates to appropriate internal departments.
- Create, organize and maintain client files.
- Ensure adherence to each client's contractual Statement of Work, and other contractual obligations as appropriate.
- Receive, document, process and forward all provider nomination inquiries to our provider networks department.
- Performs administrative functions as needed (copying, assembling binders, mailing, etc.).
- Perform other projects and responsibilities as requested
- Other job-related duties as assigned.
POSITION QUALIFICATIONS
Competency Statement(s)
- Accuracy/Quality - Accuracy looks at the extent to which an individual's work is correct and error free within company policies and guidelines. This competency asks the question "How well do you perform your work, and check the quality of the work before passing it along?"
- Decision Making - Decision making skills look at the ability of the individual to select an effective course of action while controlling resources and expenditures. The ability to make decisions and the quality and timeliness of those decisions. This competency asks the question "How well do you evaluate information and decide on an appropriate course of action?"
- Initiative and Creativity - Initiative looks at the ability of the individual to go ahead with a task without being told every detail. The ability to make constructive suggestions. This competency asks the question "How confident are you in making decisions on the basis of your own initiative?"
- Judgment - The skill of judgment looks at the ability of the individual to form sound opinions or make decisions by evaluating available information. This competency asks the question "How do you make decisions?"
- Project Management/Planning and Organizing - Project management skills looks at the ability of the individual to demonstrate an understanding of planning, organizing, staffing, directing, and controlling work tasks. The ability to analyze work, set goals, develop plans of action, utilize time. This competency asks the question "How well do you direct people and control deadlines to meet a specific goal?"
- Job Knowledge - Knowledge of job and policies/procedures that apply to one's job.
- Autonomy - Ability to work independently with minimal supervision.
- Communication, Oral - Ability to communicate effectively with others using the spoken word.
- Communication, Written - Ability to communicate in writing clearly and concisely.
- Detail Oriented - Ability to pay attention to the minute details of a project or task.
- Organized - Possessing the trait of being organized or following a systematic method of performing a task.
- Customer Oriented - Ability to take care of the customers' needs while following company procedures.
- Interpersonal - Ability to get along well with a variety of personalities and individuals.
- Tactful - Ability to show consideration for and maintain good relations with others.
- Active Listening - Ability to actively attend to, convey, and understand the comments and questions of others.
PREFERRED SKILLS & ABILITIES
Education: Bachelor's Degree preferred (four-year college or university) or four to six years of related experience.
Experience: One to three years' experience working in an Account Manager role preferred. Knowledge and understanding of Third-Party Administrator (TPA) role in managing medical claims processing is preferred. Experience working with, or for, Correctional Facilities is preferred. Minimum of two years' experience in an account manager role within the Health Care Insurance industries preferred.
Computer Skills: Microsoft Office Suite, including, Word, PowerPoint, and excellent Excel Skills, Microsoft Outlook, Internet, Salesforce
Certificates & Licenses:
Valid State issued driver's license
Additional Skills: Ability to fluently speak, read, and write in English.
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Heritage Health Solutions, Inc.
$50,000 to $70,000 DOE - Pay is dependent on experience and qualifications. Benefits package: Employer heavily subsidized Medical, Dental, Vision. Employer paid life insurance, AD&D, STD, LTD. Voluntary life insurance available as well as other supplement
Aug 05, 2025