Provider Engagement Account Manager
About The Position
Maintain partnerships between the health plan and contracted provider networks serving local communities. Build client relationships to support the highest level of care for members. Engage providers to identify network performance opportunities and solutions, provide consultative account management, and ensure accountability for issue resolution. Drive performance in contract incentives, quality, and cost utilization. This field-based role supports a 30-county territory in North Georgia. Candidates must reside in Fannin, Gilmer, Union, or Lumpkin County, Georgia. Regular travel throughout the broader territory is required, including travel four days per week.
Requirements
- Bachelor’s degree in a related field or equivalent experience.
- Two years of experience in managed care or a medical group, provider relations, quality improvement, claims, contracting, utilization management, or clinical operations.
- Project management experience in a medical group, IPA, or health plan setting.
- Proficiency in HEDIS/quality measures, cost, and utilization.
- Must reside in Fannin, Gilmer, Union, or Lumpkin County, Georgia.
- Ability to travel locally four days a week.
Nice To Haves
- Knowledge of Risk Adjustment and value-based care (VBC).
Responsibilities
- Serve as the primary contact for providers and act as a liaison between providers and the health plan.
- Triage provider issues and coordinate resolution with internal partners.
- Receive and effectively respond to external provider-related issues.
- Investigate, resolve, and communicate provider claim issues and changes.
- Initiate data entry for provider demographic information changes.
- Educate providers on policies and procedures related to referrals, claims submission, website usage, EDI solicitation, and related topics.
- Conduct provider orientations and ongoing provider education, including writing and updating orientation materials.
- Manage network performance for the assigned territory using a consultative account-management approach.
- Evaluate provider performance and develop strategic plans to improve it.
- Drive provider performance improvement in Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost, and utilization.
- Complete special projects as assigned.
- Travel locally four days a week.
- Perform other duties as assigned.
- Comply with all policies and standards.
Benefits
- Competitive pay
- Health insurance
- 401(k)
- Stock purchase plans
- Tuition reimbursement
- Paid time off and holidays
- Flexible work approach, with remote, hybrid, field, or office schedules
- Potential additional forms of incentives
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
