Provider Relationship Account Manager

Role Overview

• Develops and maintains positive provider relationships with the provider community by regular on-site and/or virtual/digital visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues
• Serves as a knowledge and resource expert regarding provider issues impacting provider satisfaction and network retention; researches, analyzes, and coordinates prompt resolution to complex provider issues and appeals through direct contact with providers and internal matrixed partners
• Collaborates within a cohort of internal matrix partners to triage issues and submit work requests
• Generally, is assigned to a portfolio of providers within a defined cohort
• Coordinates Joint Operation Committees (JOC) of provider groups, driving the meetings in the discussion of issues and changes
• May assist Annual Provider Satisfaction Surveys, required corrective action plan implementation and monitoring education, contract questions and non-routine claim issues
• Coordinates communications process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns
• Conducts proactive outreach to support the understanding of managed care policies and procedures, as well as on a variety of initiatives and programs
• Participates in external Provider Townhalls/Seminars and attends State Association conferences (e.g.: MGMA, AFP, AAP, HFMA)
• Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery
• Research issues that may impact future provider contract negotiations or jeopardize network retention

Requirements

• Requires a bachelor’s degree
• minimum of 3 years of customer service experience including 2 years of experience in a healthcare or provider environment
• Provider relations experience strongly preferred
• Experience with medical coding/terminology preferred
• Proficiency with Microsoft Office products, most notably expertise in Excel for reporting, Word, PowerPoint, Teams, and Outlook strongly preferred
• Travels to worksite and other locations as necessary

Benefits

• a comprehensive benefits package
• incentive and recognition programs
• equity stock purchase and 401k contribution