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, claim resolution, and provider education materials
Domain
Healthcare / Managed Care
Deliverable
client delivery
Required skills
Provider relations, claims management, data analytics, performance evaluation, strategic planning, HEDIS/quality measures, cost and utilization management
Preferred skills
Project management, clinical operations, contract utilization management
Technologies
EDI, web portals
Responsibilities
Serve as primary contact for providers and liaison to the health plan; triage and resolve provider claim issues; educate providers on policies, referrals, and claims submission; conduct provider orientations and update materials; manage network performance through consultative account management; evaluate provider performance and develop strategic improvement plans; track metrics like Risk/P4Q, HBR, and HEDIS; conduct regular in-person visits with physicians to discuss performance and care optimization.
Seniority
Mid-level, hands-on IC
