Provider Engagement Account Manager (Northeast PA)
Core
Maintain partnerships between the health plan and contracted provider networks in Northeast PA to ensure high-quality care delivery and optimal network performance.
Role type
Provider Engagement Account Manager
Builds
Provider network performance, quality metrics, and cost utilization for health plan members
Domain
Healthcare / Managed Care
Deliverable
client delivery
Required skills
consultative account management, provider relations, claims investigation, data entry, provider orientation, performance evaluation, strategic planning, HEDIS/quality measures, cost and utilization analysis
Preferred skills
project management, contract incentive management
Technologies
EDI, web portals
Responsibilities
Serve as primary contact for providers and liaison to the health plan; triage and resolve provider issues and claim changes; educate providers on policies, procedures, and EDI; manage network performance through consultative account management; evaluate provider performance and develop strategic improvement plans; drive improvements in risk, quality, and cost utilization.
Seniority
Mid-level, hands-on IC
