MyCare Medical · 6 days ago
Account Manager, Provider Relations
Spring, PA
Full-time
Onsite
Entry Level
1+ years expMyCare Medical Group is a healthcare organization committed to delivering high-quality, cost-effective care. They are seeking an experienced Account Manager, Provider Relations to manage relationships with Affiliate MSO Medicare Advantage providers in the Houston market, ensuring effective communication and support on various operational topics.
Health CareMedicalPrimary and Urgent CareWellness
Responsibilities
Owns and manages contractual relationship and performance of assigned in-network Affiliate provider groups
Serves as primary point of contact for assigned providers
Evaluates provider performance via Affiliate Provider Dashboard and develops performance action plans
Completes new provider orientation for all applicable product lines to educate on policies and initiatives, resolve issues, and educate staff/providers
Drives adoption, discussions and utilization of Provider Payor Portals, including Medcloud, AaNeelCare, Accureports (Rx, Hospital and ER Discharge, Medical Expenses via PMPM views), VIM, HealthJump, and others
Establishes consistent and strong relationships with provider groups utilizing an account management approach
Establishes and leads cross-functional communication with internal departments, including but not limited to MRA and HEDIS
Collaborates with internal cross-functional team to support provider performance and resolve barriers and challenges on a monthly basis
Drives improvement of provider performance by educating, analyzing, interpreting, communicating utilization and quality metrics. Responsible for developing and executing performance improvement plans
Has understanding and explains full risk contract reimbursement to providers and management leads cross-functional communication and works with internal support team to resolve provider contractual inquiries
Plans, prepares, and executes effective group monthly meetings/discussion with proper objectives and expected outcomes with cross-functional communication on internal and external customers
Maintains provider data integrity including monitoring provider credentialing, location additions, demographic updates, and terminations
Provides continual training to assigned providers on provider portal and other resources to assist with claims, authorizations, member support, etc
Provides oversight of delegated functions, as applicable
Performs special projects/campaigns as assigned
Partners with Network Development to identify network gaps and suggests additional providers for recruitment to ensure network adequacy, working with internal support team
Qualification
Required
Bachelor's degree in healthcare administration, business, or a related field, OR with equivalent demonstrated work experience
Minimum of 1 year of experience required working in Provider Relations, Account Management, Customer Service, or relevant position with demonstrated ability to perform the required responsibilities and duties
Must be well-versed in HEDIS & MRA compliance; preferably within a managed care environment
Excellent computer skills, specifically with Microsoft Office (Office 365) applications (Outlook, Excel, Word)
Must have excellent verbal and written communication skills
Ability to multitask and organize priority of work throughout the day, managing their time accordingly, and be flexible in a results-driven, fast-paced, growth oriented, emerging company
Ability to self-direct and work autonomously and independently while consistently showing self-initiative
Detail-oriented with strong analytical and problem-solving skills
Ability to represent the company with external constituents, including demonstrating exceptional interpersonal skills and building rapport
Must live within the Houston, Texas region
Travel required; Must have reliable form of transportation, with the ability to travel within the market region approximately 75% of the time
Preferred
Experience working in healthcare with an IPA/MSO/HMO/PPO environment preferred
Case Management experience is desirable and would be ideal for success in this role
Bilingual English/Spanish preferred
Company
MyCare Medical
MyCare Medical is a primary care group that provides high-quality patient care in a value-based model.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Gautam Shirhattikar
Chief Executive Officer
Claudio Micieli, MPH
Chief Operating Officer
Recent News
2025-08-13
Company data provided by crunchbase