Provider Relationship Account Manager
About The Position
Provider Relationship Account Manager Location: Hybrid1: This role requires associates be in the office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Provider Relationship Account Manager is r esponsible for providing quality, accessible and comprehensive service to the company's provider community. How you will make an impact: Develops and maintains positive provider relationships with the provider community by regular on-site and/or virtual/digital visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues. Serves as a knowledge and resource expert regarding provider issues impacting provider satisfaction and network retention; researches, analyzes, and coordinates prompt resolution to complex provider issues and appeals through direct contact with providers and internal matrixed partners. Collaborates within a cohort of internal matrix partners to triage issues and submit work requests. Generally, is assigned to a portfolio of providers within a defined cohort. Coordinates Joint Operation Committees (JOC) of provider groups, driving the meetings in the discussion of issues and changes. May assist Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education, contract questions and non-routine claim issues. Coordinates communications process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns. Conducts proactive outreach to support the understanding of managed care policies and procedures, as well as on a variety of initiatives and programs. Participates in external Provider Townhalls/Seminars and attends State Association conferences (e.g.: MGMA, AFP, AAP, HFMA). Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery. Research issues that may impact future provider contract negotiations or jeopardize network retention.
Requirements
- Requires a bachelor’s degree
- minimum of 3 years of customer service experience including 2 years of experience in a healthcare or provider environment
- or any combination of education and experience, which would provide an equivalent background.
- Travels to worksite and other locations as necessary.
Nice To Haves
- Provider interface experience strongly preferred.
- National account knowledge strongly preferred
Responsibilities
- Develops and maintains positive provider relationships with the provider community by regular on-site and/or virtual/digital visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues.
- Serves as a knowledge and resource expert regarding provider issues impacting provider satisfaction and network retention; researches, analyzes, and coordinates prompt resolution to complex provider issues and appeals through direct contact with providers and internal matrixed partners.
- Collaborates within a cohort of internal matrix partners to triage issues and submit work requests.
- Generally, is assigned to a portfolio of providers within a defined cohort.
- Coordinates Joint Operation Committees (JOC) of provider groups, driving the meetings in the discussion of issues and changes.
- May assist Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education, contract questions and non-routine claim issues.
- Coordinates communications process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns.
- Conducts proactive outreach to support the understanding of managed care policies and procedures, as well as on a variety of initiatives and programs.
- Participates in external Provider Townhalls/Seminars and attends State Association conferences (e.g.: MGMA, AFP, AAP, HFMA).
- Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery.
- Research issues that may impact future provider contract negotiations or jeopardize network retention.
Benefits
- a comprehensive benefits package
- incentive and recognition programs
- equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs (unless covered by a collective bargaining agreement)
- medical, dental, vision, short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs and financial education resources
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
5,001-10,000 employees
