Fallon Health ACO Account Executive in Worcester, Massachusetts
About Fallon Health
Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.
Brief Summary of Purpose : The ACO Account Executive is responsible for building and maintaining relationships with Fallon’s ACO Provider Partners. This role will oversee the ACO Provider Partner’s Governance Structure and function as liaison for the Provider Partners as necessary. The ACO Account Executive will partner closely with the ACO Program Manager IV to resolve any operational issues raised by Provider Partners. The ACO Account Executive will also partner closely with the Fallon Contract Managers responsible for the overseeing the 3 ACO contracts.
Ensure ACO Governance meetings are scheduled in the frequency dictated by the ACO Contract
Validate appropriate representation will be in attendance with the quorum needed for each
Draft agenda and materials, working closely with the Vice President Product Management, as needed
Ensure proper meeting documentation is developed and maintain the ACO Sharepoint Site with all finalized materials
Occasionally represent Fallon at ACO Governance meetings when Vice President Product Management is unavailable
Building long-lasting, mutually beneficial relationships with external contacts and internal departments to create a better customer experience. Support and solve problems for clients by understanding and exceeding their expectations.
Act as liaison between Fallon and ACO Partners on day to day issues surrounding the ACO. Remain in frequent contact with the clients in your responsibility to understand their needs
Partner closely with the ACO Program Manager IV to resolve any operational issue raised by the ACO Partner
Understand and explain the financial arrangements with both the state and provider partners.
Manages complex negotiations. Understand the financial implications to both the provider partners as well as Fallon’s bottom line. Ensure that any terms agreed upon by Fallon and provider partner are in compliance with the contract between Fallon and the state. Additionally, vet operational feasibility prior to disclosing terms with provider partners.
Participates in strategy development and ongoing planning and analysis. Accurately forecasts membership volumes and communicates timely updates to internal and external stakeholders.
Implements, manages and refines business processes required to deliver expected business results.
Work closely with Medical Economics to deliver requested reports from ACO Partners. Gain an understanding of these reports and be able to explain their content to business partners as needed.
Partner closely with the Contract Managers for each ACO contract. Understand the various nuances associated with each contract and monitor the financials of each ACO.
Facilitate ACO partner related deliverables to MassHealth. Monitor MassHealth communications for activity and proactively outreach to ACO Partners around deliverables and timelines. Provide assistance from Fallon Health to complete deliverables as needed.
Assist with the annual budget process and ongoing financial improvement activities.
Represent FCHP at various Provider Events across the Commonwealth. Seek out opportunities to cultivate relationships throughout the service area and improve Fallon’s brand.
Bachelors’ degree required, masters preferred.
7-10 years’ experience in managed care required. Managed care experience with knowledge of plan operations, finance, product implementation, marketing and product management Experience with, M/S Product Suite and Sharepoint.
Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
Posted Date 2 months ago (2/18/2020 4:31 PM)
Job ID 5913
# Positions 1
Category Medicare Medicaid Programs