Provider Engagement Account Manager

$54,000 - $97,100/Yr

Centene

Full-time - Mid Level

Ambulatory Health Care Services

About the position

The Provider Engagement Account Manager plays a crucial role in maintaining partnerships between the health plan and contracted provider networks, ensuring the delivery of high-quality care to members. This position involves engaging with providers to identify performance opportunities, managing client relations, and resolving issues effectively. The role requires a consultative approach to drive optimal performance in contract incentives, quality, and cost utilization.

Responsibilities

• Serve as primary contact for providers and act as a liaison between the providers and the health plan.
• Triages provider issues as needed for resolution to internal partners.
• Receive and effectively respond to external provider related issues.
• Investigate, resolve and communicate provider claim issues and changes.
• Initiate data entry of provider-related demographic information changes.
• Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics.
• Perform provider orientations and ongoing provider education, including writing and updating orientation materials.
• Manage network performance for assigned territory through a consultative/account management approach.
• Evaluate provider performance and develop strategic plans to improve performance.
• Drive provider performance improvement in areas such as Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization.
• Complete special projects as assigned.
• Comply with all policies and standards.

Requirements

• Bachelor's degree in related field or equivalent experience.
• Two years of managed care or medical group experience, provider relations, quality improvement, claims, contracting utilization management, or clinical operations.
• Project management experience at a medical group, IPA, or health plan setting.
• Proficient in HEDIS/Quality measures, cost and utilization.

Benefits

• Competitive pay
• Health insurance
• 401K and stock purchase plans
• Tuition reimbursement
• Paid time off plus holidays
• Flexible work schedules including remote, hybrid, field or office work options.