Provider Engagement Account Manager/Behavioral Health

Centene Management Company•Jackson, MS

7h•Hybrid

About The Position

Maintain and strengthen partnerships between the health plan and the contracted Behavioral Health provider networks serving our communities. Serve as a strategic consultative liaison ensuring delivery of the highest level of care to our members. Engage with providers to align network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive optimal performance incentive performance, quality, and cost utilization. Serve as primary contact for providers and act as a liaison between the providers and the health plan. Receive and effectively respond to external provider related issues. Completes special projects as assigned. Ability to travel locally 2-4 days a week. Complies with all policies and standards. Conducts regular in-person and virtual visits with Behavioral Health physicians to provide real-time support for Claims, Credentialing, and Care Management, UM, Network, and Compliance. Educate providers regarding policies and procedures related to referrals, claims submission, credential documentation, self-service tools, websites, Electronic Health Records, Health Information Exchange, and Electronic Data Interface. Investigate, document, and drive resolution of Behavioral Health provider concerns, ensuring timely follow-up and clear communication. Receive, triage, and resolve provider-related issues in coordination with internal partners including claims, credentialing, care management, utilization management, network, and compliance. Build and sustain collaborative, solution-oriented partnerships that enhance provider satisfaction and network stability. Ensure effective escalation and tracking of issues through closure. Translate complex claims and utilization data into clear, actionable insight for providers and internal stakeholders. Partner with analytics, finance, and operations teams to ensure data accuracy and alignment. Perform other duties as assigned.

Requirements

Bachelor’s degree in related field or equivalent experience.
Two years of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, or clinical operations.
Project management experience at a medical group, IPA, or health plan setting.
Proficient in HEDIS/Quality measures, cost and utilization.
Minimum of two (2) years of provider engagement or account management experience, preferably within Behavioral Health in a health plan, IPA, medical group, or similar healthcare setting.
Hands-on experience supporting provider operations, including claims processing and analysis, billing workflows, credentialing, and provider office management.
Demonstrated ability to analyze and interpret claims and utilize data to identify trends, resolve provider issues, and support performance improvement discussions.
Experience collaborating cross-functionally with Claims, Network, Credentialing, Care Management, and Compliance teams to drive issue resolution and performance outcomes.

Nice To Haves

Direct experience working with Behavioral Health providers (psychiatry, therapy, substance use, crisis services, etc.) strongly preferred.

Responsibilities

Maintain and strengthen partnerships between the health plan and the contracted Behavioral Health provider networks.
Serve as a strategic consultative liaison ensuring delivery of the highest level of care to our members.
Engage with providers to align network performance opportunities and solutions.
Provide consultative account management and accountability for issue resolution.
Drive optimal performance incentive performance, quality, and cost utilization.
Serve as primary contact for providers and act as a liaison between the providers and the health plan.
Receive and effectively respond to external provider related issues.
Completes special projects as assigned.
Conducts regular in-person and virtual visits with Behavioral Health physicians to provide real-time support for Claims, Credentialing, and Care Management, UM, Network, and Compliance.
Educate providers regarding policies and procedures related to referrals, claims submission, credential documentation, self-service tools, websites, Electronic Health Records, Health Information Exchange, and Electronic Data Interface.
Investigate, document, and drive resolution of Behavioral Health provider concerns, ensuring timely follow-up and clear communication.
Receive, triage, and resolve provider-related issues in coordination with internal partners including claims, credentialing, care management, utilization management, network, and compliance.
Build and sustain collaborative, solution-oriented partnerships that enhance provider satisfaction and network stability.
Ensure effective escalation and tracking of issues through closure.
Translate complex claims and utilization data into clear, actionable insight for providers and internal stakeholders.
Partner with analytics, finance, and operations teams to ensure data accuracy and alignment.
Perform other duties as assigned.