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
Account Manager (Provider Relations)
Builds
Provider network performance and client relations
Domain
Healthcare / Managed Care
Deliverable
client delivery
Required skills
consultative account management, provider performance evaluation, contract incentive management, quality measure analysis (HEDIS), cost and utilization management, claims issue resolution, provider education and orientation, strategic planning
Preferred skills
project management, data entry
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; manage network performance and develop strategic improvement plans; drive performance in risk, quality, and cost/utilization areas; complete special projects.
Seniority
Mid-level, hands-on IC