Provider Relations Account Manager - OH

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 education
• Three (3) years of relevant account management, claims, operational and technical or business work experience required
• Two (2) years of relevant Provider Relations experience supporting a provider network required
• Knowledge of Medicaid and Medicare required
• Experience translating business and contractual requirements required
• Experience with Facets and other operational systems preferred

Competencies, Knowledge and Skills:

• Proficient in Microsoft Office tools, including Project, Word, and Excel
• Advanced troubleshooting, critical thinking, and problem-solving capabilities
• Proven ability to effectively interact with all levels of management within the organization
• Flexibility during organizational and/or business changes
• Demonstrate excellent collaboration skills
• Demonstrate sense of urgency
• Ability to effectively and efficiently work within a team
• Exceptional written and verbal communication skills
• Strong interpersonal and relationship building skills
• Ability to work independently and within a team environment
• Ability to multi-task and prioritize work to meet project deadlines
• Critical listening and thinking skills
• Time management skills
• Customer service oriented
• Decision making/problem solving skills

Licensure and Certification:

• Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

• This is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essential. Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time. Must reside in the same territory they are assigned to work in; exceptions may be considered, due to business need May be required to travel greater than 50% of time to perform work duties. Required to use general office equipment, such as a telephone, photocopier, fax machine, and computer Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members
• May be required to work additional hours and/or outside normal business hours as needed to meet deadlines.
• Must reside in the state of Ohio per provider agreement guidelines
• Over 50% (Mobile) Routine travel required

Compensation Range:

$72,200.00 - $115,500.00

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

 

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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