Commercial Insurance CSR / Account Manager
COVU
Provider Engagement Account Manager
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Remote • New York, Oklahoma • 🇺🇸 United States
Visit company websiteSalary
💰 $55,100 - $99,000 per year
Job Level
JuniorMid-Level
About the role
- 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
- Triage 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
- Perform provider orientations and ongoing provider education
- Manage Network performance for assigned territory through a consultative/account management approach
- Evaluate provider performance and develop strategic plan to improve performance
- Complete special projects as assigned
- Conduct 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
Requirements
- 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
Benefits
- competitive pay
- health insurance
- 401K and stock purchase plans
- tuition reimbursement
- paid time off plus holidays
- flexible approach to work with remote, hybrid, field or office work schedules
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
data entryprovider relationsquality improvementclaims managementcontractingutilization managementclinical operationsproject managementHEDIScost utilization
Soft skills
client relationsconsultative account managementissue resolutioncommunicationeducationperformance evaluationstrategic planningproblem-solvinginterpersonal skillsliaison
