Peach State Health Plan
Provider Engagement Account Manager
Peach State Health Plan, Atlanta, Georgia, United States, 30383
Location
Centene – Atlanta, GA (Georgia – Hall, Banks, Lumpkin, Madison, or Jackson counties) Position Overview
Centene is transforming the health of our communities, one person at a time. This role maintains partnerships between the health plan and contracted provider networks to deliver the highest level of care to our members. The primary focus is on building client relations, engaging with providers, aligning on network performance opportunities, and providing consultative account management and issue resolution. Responsibilities
Serve as the primary contact for providers and act as a liaison between 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, website usage, EDI solicitation and related topics. Perform provider orientations and ongoing provider education, including writing and updating orientation materials. Manage network performance for the assigned territory through a consultative/account management approach. Evaluate provider performance and develop a strategic plan to improve performance. Drive provider performance improvement in areas such as Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization. Complete special projects as assigned. Travel locally 4 days a week. Perform other duties as assigned. Comply with all policies and standards. 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. Collaborate with physicians to identify and align with performance-based agreements that incentivize better patient outcomes, cost-efficiency, and quality care. Use data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets. Qualifications
Bachelor’s degree in a 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. Proficiency in HEDIS/Quality measures, cost and utilization. Compensation & Benefits
Pay Range: $55,100.00 – $99,000.00 per year. Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
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Centene – Atlanta, GA (Georgia – Hall, Banks, Lumpkin, Madison, or Jackson counties) Position Overview
Centene is transforming the health of our communities, one person at a time. This role maintains partnerships between the health plan and contracted provider networks to deliver the highest level of care to our members. The primary focus is on building client relations, engaging with providers, aligning on network performance opportunities, and providing consultative account management and issue resolution. Responsibilities
Serve as the primary contact for providers and act as a liaison between 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, website usage, EDI solicitation and related topics. Perform provider orientations and ongoing provider education, including writing and updating orientation materials. Manage network performance for the assigned territory through a consultative/account management approach. Evaluate provider performance and develop a strategic plan to improve performance. Drive provider performance improvement in areas such as Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization. Complete special projects as assigned. Travel locally 4 days a week. Perform other duties as assigned. Comply with all policies and standards. 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. Collaborate with physicians to identify and align with performance-based agreements that incentivize better patient outcomes, cost-efficiency, and quality care. Use data analytics to track and monitor provider performance, offering actionable feedback to help physicians optimize care delivery and meet key performance targets. Qualifications
Bachelor’s degree in a 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. Proficiency in HEDIS/Quality measures, cost and utilization. Compensation & Benefits
Pay Range: $55,100.00 – $99,000.00 per year. Centene offers a comprehensive benefits package including competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act.
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