Provider Engagement Account Manager

$54,000 - $97,100/Yr

Centene - Miami, FL

Full-time - Mid Level

Miami, FL

5,001-10,000 employees

Ambulatory Health Care Services

About the position

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

Responsibilities

• Maintain partnerships between the health plan and contracted provider networks.
• Build client relations to ensure delivery of the highest level of care to members.
• Engage with providers to align on network performance opportunities and solutions.
• Consultative account management and accountability for issue resolution.
• Drive optimal performance in contract incentive performance, quality, and cost utilization.
• 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.
• Act as a liaison between Tier III and Tier IV providers and the health plan.

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

• 401(k)
• Health insurance
• Paid holidays
• Paid time off
• Tuition reimbursement