VBC Account Manager

MyCare Medical; Town of Florida (NY); On-site; USD 65,000 - 95,000; Full time

Job summary

MyCare Medical Group in Broward County, FL is seeking an experienced Account Manager, Provider Relations to support communication with Affiliate MSO Medicare Advantage providers. You will own provider accounts, guide clinical staff, and coordinate with internal teams on service, network, utilization, claims and credentialing.

You will manage performance via dashboards, conduct provider orientation, promote use of provider portals, and drive ongoing improvements through data analysis and

Qualifications

• Bachelor's degree in healthcare administration, business, or related field, or equivalent demonstrated work experience.
• Minimum of 1 year of experience in Provider Relations, Account Management, Customer Service, or relevant role.
• Experience in healthcare with IPA/MSO/HMO/PPO environment preferred.
• Case Management experience desirable and beneficial for success.
• Strong knowledge of HEDIS & MRA compliance; managed care background preferred.
• Excellent computer skills, particularly Microsoft Office (Office 365) applications.
• Excellent verbal and written communication skills.
• Ability to multitask, prioritize, and work independently in a fast-paced environment.

Responsibilities

• 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 creates actionable improvement plans.
• Completes new provider orientation for applicable product lines.
• Drives adoption of Provider Payor Portals and related reporting tools.
• Establishes strong relationships with provider groups using an account-management approach.
• Coordinates cross-functional communication with internal departments (MRA, HEDIS).
• Drives data-driven improvements and communicates utilization and quality metrics.
• Explains contract reimbursement and handles provider inquiries with internal teams.
• Plans and executes monthly provider meetings with clear objectives.
• Maintains provider data integrity and credentialing activity.
• Provides ongoing training on provider portals and resources.
• Oversees delegated functions as applicable.
• Performs special projects/campaigns as assigned.

Skills

Verbal communication

Written communication

Analytical skills

Multitasking

Independent work

Bilingual English/Spanish

Education

Bachelor's degree in healthcare administration, business, or related field

Tools

Power BI

AccuReports

VIM

Switchboard

Smartlink

Job description

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.

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.
• Bilingual English/Spanish preferred.
• 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.

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