Provider Engagement Account Manager
Core
Maintain partnerships between the health plan and contracted provider networks to ensure high-quality care delivery and optimal network performance.
Role type
Provider Engagement Account Manager
Builds
Provider network performance and member care delivery
Domain
Healthcare / Managed Care
Deliverable
dashboards & analysis
Required skills
Provider relations, claims management, data entry, provider education, performance evaluation, strategic planning, HEDIS/quality measures, cost and utilization management
Preferred skills
Project management, contract negotiation
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, referrals, and claims submission; perform provider orientations and update materials; manage network performance and develop strategic improvement plans; drive performance in Risk/P4Q, HBR, HEDIS, cost, and utilization; complete special projects.
Seniority
Mid-level, hands-on IC
