Provider Engagement Account Manager – Behavioral Health
Centene Corporation
full-time
Posted on:
Location Type: Remote
Location: Mississippi • United States
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Salary
💰 $56,200 - $101,000 per year
About the role
- Maintain and strengthen partnerships between the health plan and the contracted Behavioral Health provider networks serving our communities
- Serve as a strategic consultative liaison ensuring delivery of the highest level of care to our members
- Engage with providers to align network performance opportunities and solutions, and consultative account management and accountability for issue resolution
- Drive optimal performance incentive performance, quality, and cost utilization
- Serve as primary contact for providers and act as a liaison between the providers and the health plan
- Receive and effectively respond to external provider related issues
- Completes special projects as assigned
- Ability to travel locally 2-4 days a week
- Complies with all policies and standards
- Conducts regular in-person and virtual visits with Behavioral Health physicians to provide real-time support for Claims, Credentialing, and Care Management, UM, Network, and Compliance
- Educate providers regarding policies and procedures related to referrals, claims submission, credential documentation, self-service tools, websites, Electronic Health Records, Health Information Exchange, and Electronic Data Interface
- Investigate, document, and drive resolution of Behavioral Health provider concerns, ensuring timely follow-up and clear communication
- Receive, triage, and resolve provider-related issues in coordination with internal partners including claims, credentialing, care management, utilization management, network, and compliance
- Build and sustain collaborative, solution-oriented partnerships that enhance provider satisfaction and network stability
- Ensure effective escalation and tracking of issues through closure
- Translate complex claims and utilization data into clear, actionable insight for providers and internal stakeholders
- Partner with analytics, finance, and operations teams to ensure data accuracy and alignment
- Perform other duties as assigned
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
- Direct experience working with Behavioral Health providers (psychiatry, therapy, substance use, crisis services, etc.) strongly preferred
- Minimum of two (2) years of provider engagement or account management experience, preferably within Behavioral Health in a health plan, IPA, medical group, or similar healthcare setting
- Hands-on experience supporting provider operations, including claims processing and analysis, billing workflows, credentialing, and provider office management
- Demonstrated ability to analyze and interpret claims and utilize data to identify trends, resolve provider issues, and support performance improvement discussions
- Experience collaborating cross-functionally with Claims, Network, Credentialing, Care Management, and Compliance teams to drive issue resolution and performance outcomes
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 & Tools
HEDISclaims processingcredentialingutilization managementdata analysisperformance improvementbilling workflowsprovider operationsquality improvementaccount management
Soft Skills
communicationcollaborationproblem-solvingconsultative skillsrelationship managementstrategic thinkingissue resolutionproject managementanalytical thinkingcustomer service