Senior Provider Engagement Account Manager
Core
Develop strategic partnerships between the health plan and contracted provider networks to align on network performance, issue resolution, and contract incentive optimization.
Role type
Senior Provider Engagement Account Manager
Builds
Network performance strategies and provider engagement solutions
Domain
Healthcare / Managed Care
Deliverable
client delivery
Required skills
consultative account management, provider relations, claims investigation, HEDIS/quality measures, cost and utilization analysis, strategic planning, provider education, report creation, coaching
Preferred skills
project management, value based performance (VBP) tools proficiency
Technologies
EDI, web portals, reporting tools
Responsibilities
Serve as primary contact for providers and liaison to the health plan; Identify and deliver solutions to provider concerns; Investigate and resolve provider claim issues; Engage and educate providers on policies, referrals, and claims submission; Perform provider orientations and update materials; Manage network performance for assigned territory; Evaluate provider performance and develop strategic improvement plans; Present HBR analysis and reports for Joint Operating Committee meetings; Coach new and less experienced External Reps.
Seniority
Senior, hands-on IC