Louisiana Healthcare Connections · 9 hours ago

Provider Engagement Account Manager

Full-time

Remote

Entry, Mid Level

$54K/yr - $97K/yr

2+ years exp

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Comp. & Benefits

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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

Manages Network performance for assigned territory through a consultative/account management approach

Evaluates provider performance and develops strategic plan to improve performance

Drives provider performance improvement in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc.

Completes special projects as assigned

Ability to travel locally 4 days a week

Performs other duties as assigned

Complies with all policies and standards

Qualification

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Managed Care ExperienceProvider RelationsQuality ImprovementHEDIS/Quality MeasuresClaims ManagementContracting Utilization ManagementClinical OperationsUtilizationProject ManagementData EntryProvider EducationIssue ResolutionStrategic Planning

Required

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.

Driver’s License required

Ability to travel locally 4 days a week.