Provider Engagement Account Manager (Northwest TX)
Core
Manage partnerships between a health plan and contracted provider networks to ensure high-quality care delivery and optimal network performance.
Role type
Field-based account manager for provider networks
Builds
Provider network performance and member care delivery
Domain
Healthcare / Managed Care
Deliverable
client delivery
Required skills
Provider relations, claims management, quality improvement (HEDIS), cost and utilization management, contract negotiation, data entry, provider education
Preferred skills
Managed care or medical group experience, project management, strategic planning
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 through consultative account management; evaluate provider performance and develop strategic improvement plans; complete special projects.
Seniority
Mid-level, hands-on IC
