Account Manager

• 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

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