Account Manager, Provider Relations

POSITION SUMMARY

MyCare Medical Group is a healthcare organization dedicated to providing high-quality, cost-effective care to its patients. We are seeking an Account Manager, Provider Relations, who will assist in communicating and disseminating information to our network of Affiliate MSO Medicare Advantage providers. This role will focus on managing provider accounts in our Central Florida market, including Tampa, to support technical needs such as service, network, MRA & HEDIS compliance, utilization, claims, and credentialing.

RESPONSIBILITIES

• Owns and manages contractual relationships and performance of assigned in-network Affiliate provider groups.
• Serves as the primary point of contact for assigned providers.
• Evaluates provider performance using the Affiliate Provider Dashboard and develops performance action plans.
• Completes new provider orientation for all applicable product lines to educate on policies and initiatives, resolve issues, and train staff/providers.
• Drives adoption and utilization of Provider Payor Portals, including Medcloud, AaNeelCare, Accureports (Rx, Hospital and ER Discharge, Medical Expenses via PMPM views), VIM, HealthJump, and others.
• Establishes consistent and strong relationships with provider groups through an account management approach.
• Collaborates with internal cross-functional teams to support provider performance and address challenges on a monthly basis.
• Improves provider performance by educating, analyzing, interpreting, and communicating utilization and quality metrics.
• Develops and executes performance improvement plans, explaining full risk contract reimbursement to providers and leading cross-functional communication with internal support teams to resolve inquiries.
• Plans, prepares, and executes effective monthly meetings with cross-functional communication on internal and external customers.
• Maintains provider data integrity by monitoring credentialing, location additions, demographic updates, and terminations.
• Provides ongoing training to assigned providers on provider portals and other resources to assist with claims, authorizations, member support, etc.
• Oversees delegated functions, as applicable.
• Partners with Network Development to identify network gaps and suggest additional providers for recruitment to ensure network adequacy, collaborating with internal support teams.

QUALIFICATIONS

• Bachelor's degree in healthcare administration, business, or a related field, or equivalent demonstrated work experience.
• Minimum of 1 year of experience required in Provider Relations, Account Management, Customer Service, or a relevant position, with the ability to perform the required responsibilities and duties.
• Experience working in healthcare, particularly within an IPA/MSO/HMO/PPO environment, is preferred.
• Case Management experience is desirable and would be beneficial for success in this role.
• Must be well-versed in HEDIS & MRA compliance, ideally within a managed care environment.
• Excellent computer skills, specifically with Microsoft Office (Office 365) applications (Outlook, Excel, Word).
• Strong verbal and written communication skills.
• Ability to multitask, organize priorities, manage time, and be flexible in a results-driven, fast-paced, growing company.
• Detail-oriented with strong analytical and problem-solving skills.
• Exceptional interpersonal skills and the ability to build rapport with external constituents.
• Bilingual English/Spanish preferred.
• Must live within the Tampa region.
• Travel required; must have reliable transportation and the ability to travel within the market region approximately 75% of the time.

PAY RANGE

$0 per hour

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