Broward Provider Relations & Performance Manager

MyCare; Florida; Hybrid; USD 70.000 - 90.000; Vollzeit

Zusammenfassung

MyCare Medical Group is seeking an experienced VBC Account Manager for the Broward, FL region to manage in-network provider relations and drive performance improvements.

The role requires coordinating with physician staff, ensuring credentialing accuracy, and guiding provider performance through dashboards and portals. Travel within the Broward market is expected.

Qualifikationen

• Bachelor's degree in healthcare administration, business, or related field, or equivalent demonstrated work experience.
• Minimum 1 year of experience in Provider Relations, Account Management, Customer Service, or related role.
• Experience in a IPA/MSO/HMO/PPO environment preferred.
• HEDIS & MRA compliance knowledge; managed care experience preferred.
• Strong MS Office (Office 365) skills; Excel proficiency.
• Excellent verbal and written communication skills.

Aufgaben

• Owns and manages contractual relationship and performance of assigned in-network Affiliate provider groups.
• Serves as primary point of contact for assigned providers.
• Evaluates provider performance via Affiliate Provider Dashboard and develops performance action plans.
• Completes new provider orientation for all applicable product lines to educate on policies and initiatives.
• Drives adoption and utilization of Provider Payor Portals, including Power BI, Acureports, VIM, Switchboard, Smartlink and others.
• Establish consistent, strong relationships with provider groups using an account management approach.
• Leads cross-functional communication with internal departments, including MRA and HEDIS.
• Collaborates with internal cross-functional team to support provider performance and resolve barriers monthly.
• Drives improvement of provider performance by educating, analyzing, interpreting, and communicating utilization and quality metrics.
• Plans, prepares, and executes effective group monthly meetings with proper objectives and outcomes.
• Maintains provider data integrity including credentialing, location additions, demographic updates, and terminations.
• Provides ongoing training to assigned providers on provider portal and resources to assist with claims, authorizations, member support, etc.
• Oversees delegated functions, as applicable.
• Performs special projects/campaigns as assigned.
• Partners with Network Development to identify network gaps and recruit additional providers.

Kenntnisse

Communication skills

Multitasking

Analytical thinking

Interpersonal skills

Time management

Ausbildung

Bachelor's degree in healthcare administration or related field

Tools

Power BI

Acureports

VIM

Switchboard

Smartlink

Provider Portals

Jobbeschreibung

VBC Account Manager, Broward, FL Region

POSITION SUMMARY:
MyCare Medical Group is a healthcare organization committed to delivering the highest quality, most cost-effective care to its patients. We are looking for an experienced Account Manager,ProviderRelations, who will be responsible for assisting in the communication and dissemination of information to the current community of Affiliate MSO Medicare Advantageproviders. This position will be assignedprovideraccounts in our Broward Market (including but not limited to Broward) to guide, manage, and communicate directly with the Physician Staff andProviders assisting with technical support on topics including but not limited to service, network, MRA & HEDIS compliance Utilization, Claims and Credentialing.

RESPONSIBILITIES:

• Owns and manages contractualrelationship and performance of assigned in-network Affiliateprovidergroups.
• Serves as primary point of contact for assignedproviders.
• Evaluatesproviderperformance via AffiliateProviderDashboard and develops performance actionable plans.
• Completes newproviderorientation for all applicable product lines to educate on policies and initiatives, resolve issues, and educate staff/providers.
• Drives adoption, discussions and utilization ofProviderPayor Portals, including Power Bi, Accureports (Rx, Hospital and ER Discharge, Medical Expenses via PMPM views), VIM, Switchboard, Smartlink and others.
• Establish consistent and strongrelationships withprovidergroups utilizing an account management approach.
• Establish and leads cross-functional communication with internal departments, including but not limited to MRA and HEDIS.
• Collaborates with internal cross-functional team to supportproviderperformance and resolve barriers and challenges on a monthly basis.
• Drives improvement ofproviderperformance by educating, analyzing, interpreting, communicating utilization and quality metrics. Responsible for developing and executing performance improvement plans.
• Has understanding and explains full risk contract reimbursement toproviders and management leads cross-functional communication and works with internal support team to resolveprovidercontractual inquiries.
• Plans, prepares, and executes effective group monthly meetings/discussion with proper objectives and expected outcomes with cross-functional communication on internal and external customers.
• Maintainsproviderdata integrity including monitoringprovidercredentialing, location additions, demographic updates, and terminations.
• Provides continual training to assignedproviders onproviderportal and other resources to assist with claims, authorizations, member support, etc.
• Provides oversight of delegated functions, as applicable.
• Performs special projects/campaigns as assigned.
• Partners with Network Development to identify network gaps and suggest additionalproviders for recruitment to ensure network adequacy, working with internal support team.

QUALIFICATIONS:

• Bachelor's degree in healthcare administration, business, or a related field, OR with equivalent demonstrated work experience.
• Minimum of 1 year of experience required working inProviderRelations, Account Management, Customer Service, or relevant position with demonstrated ability to perform the required responsibilities and duties.
• Experience working in healthcare with an IPA/MSO/HMO/PPO environment preferred.
• Case Management experience is desirable and would be ideal for success in this role.
• Must be well-versed in HEDIS & MRA compliance; preferably within a managed care environment.
• Excellent computer skills, specifically with Microsoft Office (Office 365)applications (Outlook, Excel, Word).
• Must have excellent verbal and written communication skills.
• Ability to multitask and organize priority of work throughout the day, managing their time accordingly, and be flexible in a results-driven, fast-paced, growth oriented, emerging company.
• Self-direct and work autonomously and independently while consistently showing self-initiative.
• Detail-oriented with strong analytical and problem-solving skills.
• Ability to represent the company with external constituents, including demonstrating exceptional interpersonal skills and building rapport.
• Must live within Broward Region.
• Travel required; Must have reliable form of transportation, with the ability to travel within the market region approximately 75% of the time.