Provider Engagement Account Manager
About The Position
Maintain partnerships between the health plan and the contracted provider networks serving our communities. Build client relations to ensure delivery of the highest level of care to our members. Engage with providers to align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization. This role will support greater Montgomery, Opp, Andalusia, Troy, and Enterprise. Candidates must live in Alabama within one of the covered areas. Serve as primary contact for providers and act as a liaison between the providers and the health plan. Triage provider issues as needed for resolution to internal partners. Receive and effectively respond to external provider related issues. Investigate, resolve and communicate provider claim issues and changes. Initiate data entry of provider-related demographic information changes. Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics. Perform provider orientations and ongoing provider education, including writing and updating orientation materials. Manages Network performance for assigned territory through a consultative/account management approach. Evaluates provider performance and develops strategic plan to improve performance. Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc. Completes special projects as assigned. Ability to travel locally 4 days a week. Performs other duties as assigned. Complies with all policies and standards.
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.
- Candidates must live in Alabama within one of the covered areas.
Responsibilities
- Serve as primary contact for providers and act as a liaison between the providers and the health plan
- Triage provider issues as needed for resolution to internal partners
- Receive and effectively respond to external provider related issues
- Investigate, resolve and communicate provider claim issues and changes
- Initiate data entry of provider-related demographic information changes
- Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
- Perform provider orientations and ongoing provider education, including writing and updating orientation materials
- Manages Network performance for assigned territory through a consultative/account management approach
- Evaluates provider performance and develops strategic plan to improve performance
- Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.
- Completes special projects as assigned
- Ability to travel locally 4 days a week
- Performs other duties as assigned
- Complies with all policies and standards
Benefits
- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off
- holidays
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
