Provider Engagement Account Manager

PROLIM (www.prolim.com) is currently seeking Provider Engagement Account Manager for one of our top Client for Location - Remote - Territory is Bartow County, GA but candidate can live in Cherokee, Pickens, Floyd or Bartow due to field travel required 4 days a week

Qualified candidates can directly send your updated resume and contact info via email: jayaprakash.hiremath@prolim.com

Job description:

• NOTE: For this role, due to travel requirements, we are seeking candidates who live in Georgia, specifically, Bartow, Cherokee, Floyd or Pickens counties*

Position Purpose:

Maintain partnerships between the health plan and the contracted provider networks serving our communities.

Build client relations to ensure delivery of the highest level of care to our members.

Engage with providers to align on network performance opportunities and solutions, and 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 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

Direct Provider Engagement: 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.

Value-Based Care Model: 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.

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

Education/Experience:

Bachelor's degree in related field or equivalent experience

Two years of provider engagement account management experience

Project management experience at a medical group, IPA, or health plan setting

Proficient in HEDIS/Quality measures, cost (MLR) and utilization

Required Skills

• In person provider engagement experience.
• Risk experience (Health Benefit Ratio, emergency room utilization, cost utilization-reducing high-cost drivers)

Preferred or Nice-to-have Skills

• HEDIS/Quality Improvement
• Value-based care
• Claims processing knowledge

Years of Experience: * Bachelor's degree in related field or equivalent experience and 2 years in person provider engagement experience

Industry Experience: Managed care Accountable Care Organization (ACO) or Independent Practice Association (IPA) experience

Education Requirements: * Bachelor's degree in related field or equivalent experience

About PROLIM

PROLIM is a leading provider of PLM, IoT and Digital transformation solutions to Global Fortune 1000 companies. With 9 global offices in US, India, and Australia, PROLIM has won 30+ awards and proudly serving over 1200+ customers to innovate and improve their profitability and efficiency. PROLIM was founded in 2005 and is headquartered in Farmington Hills, USA. With the global footprint and expertise in latest technologies, PROLIM can partner with you to speed up your Digital Transformation journey.