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Provider Engagement Account Manager – Southern TX
Centene Corporation. Maintain partnerships between the health plan and contracted provider networks serving communities .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in provider relations and account management, focusing on performance improvement in HEDIS/Quality measures, cost, and utilization. Capable of educating providers on policies and procedures while effectively resolving claim issues.
Highest-signal resume keywords
Provider RelationsHEDIS/Quality MeasuresClaims ResolutionAccount ManagementManaged Care Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Data EntryQuality ImprovementUtilization ManagementContractingClinical OperationsProject Management
Soft Skills
Client RelationsCommunicationProblem SolvingConsultative Approach
Industry Keywords
Health PlanProvider NetworksRisk/P4QHealth Benefit Ratio (HBR)EDI Solicitation
About the role
Key responsibilities & impact- Maintain partnerships between the health plan and contracted provider networks serving communities
- Build client relations to ensure delivery of the highest level of care to members
- Engage providers to align on network performance opportunities and solutions
- Provide consultative account management and accountability for issue resolution
- Drive optimal performance in contract incentive performance, quality, and cost utilization
- Serve as primary contact for providers and act as liaison between providers and the health plan
- Triage provider issues for resolution with internal partners
- Receive and 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, claims submission, website usage, EDI solicitation, and related topics
- Perform provider orientations and ongoing provider education
- Write and update orientation materials
- Manage network performance for assigned territory through a consultative/account management approach
- Evaluate provider performance and develop strategic plans to improve performance
- Drive provider performance improvement in Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost, and utilization
- Complete special projects as assigned
- Perform other duties as assigned
- Comply with all policies and standards
Requirements
What you’ll need- Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
- 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, clinical operations or project management experience at a medical group, IPA, or health plan setting
- Proficient in HEDIS/Quality measures, cost and utilization
- Ability to travel locally 4 days a week
- Ability to travel to Brownsville, Laredo, Eagle Pass, Corpus Christi, and Victoria
- Ability to serve as a primary provider contact and liaison
- Ability to investigate and resolve provider claim issues
- Ability to educate providers regarding policies and procedures, referrals, claims submission, website usage, and EDI solicitation
Benefits
Comp & perks- competitive pay
- health insurance
- 401K
- stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
- additional forms of incentives may be included in total compensation
- Equal opportunity employer committed to diversity