Provider Engagement Account Manager
Fidelis Care
Buffalo New York
Salary: Neg Per Hour
Position Purpose: 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
- Triages 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, web site usage, EDI
solicitation and related topics
- Perform provider orientations and ongoing provider
education, including writing and updating orientation materials
- Manages Network performance for assigned territory
through a consultative/account management approach
- Evaluates provider performance and develops strategic
plan to improve performance
- Drives provider performance improvement in the
following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost
and utilization, etc.
- Completes special projects as assigned
- Ability to travel locally 4 days a week
- Performs other duties as assigned
- Complies with all policies and standards
Job Overview
Posted Date: 08 Feb 2025
Location: Buffalo New York
Salary: Neg Per Hour
Company Information
Fidelis Care
Name: Fidelis Care
Web: https://www.fideliscare.org/