Hospital Provider Engagement Account Manager
6 days ago
Description
• 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. • 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. • Manage Network performance for assigned territory through a consultative/account management approach. • Evaluate provider performance and develop strategic plan to improve performance. • Drive provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization. • Complete special projects as assigned. • Ability to travel locally 4 days a week. • Perform other duties as assigned. • Comply 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.
Benefits
• competitive pay • health insurance • 401K and stock purchase plans • tuition reimbursement • paid time off plus holidays • flexible approach to work with remote, hybrid, field or office work schedules
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