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Oklahoma Complete Health · 2 hours ago

Provider Engagement Account Manager

Greater Enid Area

Full-time

Hybrid

Entry, Mid Level

$55K/yr - $99K/yr

2+ years exp

Oklahoma Complete Health is a national organization focused on transforming the health of communities. They are seeking a Provider Engagement Account Manager to maintain partnerships with provider networks, ensure high-quality care delivery, and drive performance improvement through consultative account management.

Health CareHospital

Responsibilities

Serve as primary contact for providers and act as a liaison between the providers and the health plan

Triages provider issues as needed for resolution to internal partners

Receive and effectively 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 and claims submission, web site usage, EDI solicitation and related topics

Perform provider orientations and ongoing provider education, including writing and updating orientation materials

Manages Network performance for assigned territory through a consultative/account management approach

Evaluates provider performance and develops strategic plan to improve performance

Drives provider performance improvement in the following areas Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization, etc

Completes special projects as assigned

Ability to travel locally 4 days a week

Performs other duties as assigned

Complies with all policies and standards

Conducts regular in-person visits with physicians to provide real-time support, discuss performance metrics, and identify opportunities for improvement in patient care and clinical practices

Focuses on value-based care model initiatives, collaborating with physicians to identify and align to performance-based agreements that incentivize better patient outcomes, cost-efficiency, and quality care

Uses data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets

Qualification

Provider relationsPerformance managementData analyticsManaged care experienceQuality improvementProject managementCommunication skillsProblem-solving skillsTeam collaboration

Required

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, or clinical operations

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