Veracity Software Inc · 1 day ago
Provider Engagement Account Manager
United States
Full-time
Remote
Entry, Mid Level
2+ years expVeracity Software Inc is seeking a Provider Engagement Account Manager to maintain and strengthen partnerships between the health plan and contracted provider networks. This role is responsible for in-person provider engagement, managing relationships, resolving issues, and driving improvements in quality, risk, and cost/utilization performance across the assigned territory.
Information TechnologySaaSSoftwareTechnical SupportWeb Development
Responsibilities
Serve as the primary point of contact for assigned providers and act as liaison between providers and Centene health plan operations
Conduct regular in-person provider visits to support physicians, review performance metrics, and identify improvement opportunities
Manage provider network performance through a consultative/account management approach
Drive provider performance improvements in: Risk / P4Q, Health Benefit Ratio (HBR), Cost and utilization (including high-cost drivers), Emergency room utilization, HEDIS/Quality (preferred)
Triage provider issues and escalate to internal teams for timely resolution
Investigate, resolve, and communicate: Provider claims issues, Changes impacting provider operations
Initiate data entry for provider demographic updates/changes
Educate providers on: Referral policies/procedures, Claims submission process, Website portal usage, EDI solicitation and related workflows
Deliver provider orientations and ongoing education (including developing/updating orientation materials)
Track provider performance using analytics and provide actionable feedback
Complete special projects and other assigned duties
Ensure compliance with all policies and standards
Qualification
Required
Valid Driver's License
2+ years of in-person provider engagement / provider account management experience
Risk performance experience, including: Health Benefit Ratio (HBR), ER utilization / utilization management, Cost utilization-reducing drivers (high-cost driver reduction)
Must live in Georgia - specifically: Bartow County, Cherokee County, Floyd County, Pickens County
Ability to travel locally 4 days per week
Preferred
HEDIS / Quality Improvement exposure
Value-Based Care experience
Claims processing knowledge
Experience in: Managed Care, ACO (Accountable Care Organization), IPA (Independent Practice Association)
Preferred: Project management experience at a medical group, IPA, or health plan setting
Preferred: Working knowledge of HEDIS/Quality, MLR, cost and utilization metrics
Company
Veracity Software Inc
The definition of Veracity is accuracy and habitual truthfulness. This truly defines our brand in simplistic terms.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Chitra Jain
Co-Founder & CEO
Manohar Suryavanshi
Founder & President
Recent News
Help Net Security
2025-04-29
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