Provider Relations Account Manager - OH - R13271

Job Summary

The Provider Relations Account Manager - OH is responsible for working in a highly matrixed organization and influencing internal stakeholder relationships. This role will engage with providers to build, manage and maintain relationships, with a strong focus on operational efficiencies, proactive engagement, and reduced burden which all leads to retention of provider relationships. The Provider Relations Account Manager plays a pivotal role within a complex organizational framework, skillfully navigating and influencing relationships with internal stakeholders to achieve cohesive collaboration.

By engaging directly with providers, this role is instrumental in establishing robust, sustainable partnerships aimed at driving operational excellence and enhancing provider satisfaction. With a strategic focus on proactive relationship management, the Account Manager works to streamline processes and facilitate communications, thereby minimizing administrative burdens and fostering long-term retention of provider relationships. Success in this position is achieved through meticulous attention to the dynamics of provider interactions, ensuring all initiatives align closely with the broader organizational goals and compliance standards.

Job Summary

The Provider Relations Account Manager - OH is responsible for working in a highly matrixed organization and influencing internal stakeholder relationships. This role will engage with providers to build, manage and maintain relationships, with a strong focus on operational efficiencies, proactive engagement, and reduced burden which all leads to retention of provider relationships. The Provider Relations Account Manager plays a pivotal role within a complex organizational framework, skillfully navigating and influencing relationships with internal stakeholders to achieve cohesive collaboration.

By engaging directly with providers, this role is instrumental in establishing robust, sustainable partnerships aimed at driving operational excellence and enhancing provider satisfaction. With a strategic focus on proactive relationship management, the Account Manager works to streamline processes and facilitate communications, thereby minimizing administrative burdens and fostering long-term retention of provider relationships. Success in this position is achieved through meticulous attention to the dynamics of provider interactions, ensuring all initiatives align closely with the broader organizational goals and compliance standards.

Essential Functions

• Own the relationship with network providers with a proactive focus on overall provider satisfaction and retention
• Develop, maintain, and enhance relationships with key stakeholders including relevant provider associations and community agencies
• Act as a liaison to providers and operations for the provider network
• Work as community partner to assist providers; develop education and establishing a proactive process for these providers
• Work in collaboration with Operations and other internal stakeholders on provider issues including researching providers claim issues and provide a professional and comprehensive response to providers
• Work with leadership team to define deliverables and timelines
• Improve Electronic Visit Verification compliance rates for provider network
• Perform virtual and in-person initial onboarding, ongoing education and training to provider network
• Prepare and lead internal and external meetings with key stakeholders
• Assist with the implementation of strategy on provider network
• SME in relationship management with internal and external stakeholders
• Collaborate with internal stakeholders to include Care Management, Utilization Management, Product Teams, Program Integrity, Regulatory and Claims to ensure providers are educated on billing practices
• Provide education to internal and external partners on provider services, billing, and portal support
• Responsible for understanding and educating providers on regulation changes and ensuring compliance with contract terms.
• Collaborate with leadership to ensure initiatives are properly managed
• Produce detailed reports, executive summaries, and business decision documents
• Provide clarification/verification for all levels regarding status/details
• Support all lines of business
• Conduct medical records retrieval via key provider contacts to support quality of care reviews and HEDIS hybrid measures
• Conduct call campaigns to help drive quality outcomes and provide education and guidance on organizational led initiatives.
• Support contracting efforts to include provider recruitment, contract language interpretation, contract retrieval, and contract loading quality assurance.
• Provide support with new product, plan implementation and updates.
• Perform any other job related duties as requested.

Education And Experience

• Bachelor's degree in project management, Business Administration, or other related field required
• Equivalent years of relevant work experience may be accepted in lieu of required…