Veracity Software Pvt. Ltd. · 1 day ago
Provider Engagement Account Manager
Big Canoe, GA
Full-time
Hybrid
Entry, Mid Level
2+ years expVeracity Software Pvt. Ltd. is seeking a Provider Engagement Account Manager to maintain and strengthen partnerships between health plans and contracted provider networks. This role involves in-person provider engagement, managing relationships, resolving issues, and improving quality and cost/utilization performance within the assigned territory.
Information Technology & Services
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)
Risk performance experience, including ER utilization / utilization management
Risk performance experience, including 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
Bachelor's degree in related field OR equivalent experience
Minimum 2 years provider engagement account management experience
Preferred
HEDIS / Quality Improvement exposure
Value-Based Care experience
Claims processing knowledge
Experience in Managed Care
Experience in ACO (Accountable Care Organization)
Experience in IPA (Independent Practice Association)
Project management experience at a medical group, IPA, or health plan setting
Working knowledge of HEDIS/Quality
Working knowledge of MLR
Working knowledge of cost and utilization metrics
Company
Veracity Software Pvt. Ltd.
At Veracity, if you have an idea you want to validate, a product you need to build, or an existing product that needs optimization, our teams are trained to jump in wherever needed.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase