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 networks and health plan member care
Domain
Healthcare / Managed Care
Deliverable
client delivery
Required skills
Provider relations, claims management, contract utilization management, quality improvement, project management, HEDIS/Quality measures, cost and utilization analysis
Preferred skills
Experience with medical groups, IPAs, or health plans
Technologies
EDI, web portals
Responsibilities
Serve as primary contact and liaison for providers; triage and resolve provider issues and claim changes; educate providers on policies, referrals, and claims submission; manage network performance and develop strategic improvement plans; drive performance in risk, HBR, HEDIS, cost, and utilization metrics.
Seniority
Mid-level, hands-on IC
