Provider Relations Account Manager - OH

CareSource•Mobile, AL

5d•$72,200 - $115,500•Remote

About The Position

The Provider Relations Account Manager - OH is responsible for working in a highly matrixed organization and influencing internal stakeholder relationships. This role will engage with providers to build, manage and maintain relationships, with a strong focus on operational efficiencies, proactive engagement, and reduced burden which all leads to retention of provider relationships. The Provider Relations Account Manager plays a pivotal role within a complex organizational framework, skillfully navigating and influencing relationships with internal stakeholders to achieve cohesive collaboration. By engaging directly with providers, this role is instrumental in establishing robust, sustainable partnerships aimed at driving operational excellence and enhancing provider satisfaction. With a strategic focus on proactive relationship management, the Account Manager works to streamline processes and facilitate communications, thereby minimizing administrative burdens and fostering long-term retention of provider relationships. Success in this position is achieved through meticulous attention to the dynamics of provider interactions, ensuring all initiatives align closely with the broader organizational goals and compliance standards.

Requirements

Bachelor's degree in project management, Business Administration, or other related field required
Equivalent years of relevant work experience may be accepted in lieu of required education
Three (3) years of relevant account management, claims, operational and technical or business work experience required
Two (2) years of relevant Provider Relations experience supporting a provider network required
Knowledge of Medicaid and Medicare required
Experience translating business and contractual requirements required
Proficient in Microsoft Office tools, including Project, Word, and Excel
Advanced troubleshooting, critical thinking, and problem-solving capabilities
Proven ability to effectively interact with all levels of management within the organization
Flexibility during organizational and/or business changes
Demonstrate excellent collaboration skills
Demonstrate sense of urgency
Ability to effectively and efficiently work within a team
Exceptional written and verbal communication skills
Strong interpersonal and relationship building skills
Ability to work independently and within a team environment
Ability to multi-task and prioritize work to meet project deadlines
Critical listening and thinking skills
Time management skills
Customer service oriented
Decision making/problem solving skills
Must have valid driver's license, vehicle and verifiable insurance.
Employment in this position is conditional pending successful clearance of a driver’s license record check.
Influenza vaccination is a requirement of this position.
Must reside in the state of Ohio per provider agreement guidelines

Nice To Haves

Experience with Facets and other operational systems preferred

Responsibilities

Own the relationship with network providers with a proactive focus on overall provider satisfaction and retention
Develop, maintain, and enhance relationships with key stakeholders including relevant provider associations and community agencies
Act as a liaison to providers and operations for the provider network
Work as community partner to assist providers; develop education and establishing a proactive process for these providers
Work in collaboration with Operations and other internal stakeholders on provider issues including researching providers claim issues and provide a professional and comprehensive response to providers
Work with leadership team to define deliverables and timelines
Improve Electronic Visit Verification compliance rates for provider network
Perform virtual and in-person initial onboarding, ongoing education and training to provider network
Prepare and lead internal and external meetings with key stakeholders
Assist with the implementation of strategy on provider network
SME in relationship management with internal and external stakeholders
Collaborate with internal stakeholders to include Care Management, Utilization Management, Product Teams, Program Integrity, Regulatory and Claims to ensure providers are educated on billing practices
Provide education to internal and external partners on provider services, billing, and portal support
Responsible for understanding and educating providers on regulation changes and ensuring compliance with contract terms.
Collaborate with leadership to ensure initiatives are properly managed
Produce detailed reports, executive summaries, and business decision documents
Provide clarification/verification for all levels regarding status/details
Support all lines of business
Conduct medical records retrieval via key provider contacts to support quality of care reviews and HEDIS hybrid measures
Conduct call campaigns to help drive quality outcomes and provide education and guidance on organizational led initiatives.
Support contracting efforts to include provider recruitment, contract language interpretation, contract retrieval, and contract loading quality assurance.
Provide support with new product, plan implementation and updates.
Perform any other job related duties as requested.