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
Field-based Provider Engagement Account Manager
Builds
Provider network performance, claim resolution, and member care access
Domain
Healthcare / Managed Care
Deliverable
client delivery
Required skills
Provider relations, claims management, network performance analysis, HEDIS/quality measures, cost and utilization management, project management, provider education, strategic planning
Preferred skills
Risk Adjustment, Value-Based Care (VBC)
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 through consultative account management; evaluate provider performance and develop strategic improvement plans; drive performance in Risk/P4Q, HBR, HEDIS, cost, and utilization.
Seniority
Mid-level, field-based IC
