BKG Enterprises is seeking a Medicaid Provider Relationship Account Manager responsible for providing quality, accessible, and comprehensive service to the company's provider community. The role involves developing and maintaining positive provider relationships through regular on-site and/or virtual visits, communicating administrative and programmatic changes, and facilitating education and the resolution of provider issues.

Work Location:

The Medicaid Provider Relationship Account Manager position may involve a mix of on-site and remote working environments based on the organization’s policies and the specific requirements of the job.

Salary: $40.00-$46.00/hr.

Responsibilities:

• Develop and maintain positive relationships with the provider community by conducting regular on-site and/or virtual/digital visits.
• Communicate administrative and programmatic changes to providers.
• Facilitate education and resolve provider issues promptly.
• Serve as a knowledge and resource expert regarding provider issues impacting provider satisfaction and network retention.
• Research, analyze, and coordinate prompt resolutions to complex provider issues and appeals through direct contact with providers and internal matrixed partners.
• Collaborate within a cohort of internal matrix partners to triage issues and submit work requests.
• Manage a portfolio of providers within a defined cohort.
• Coordinate Joint Operation Committees (JOC) with provider groups, driving meetings to discuss issues and changes.
• Assist with Annual Provider Satisfaction Surveys, implement required corrective action plans, and monitor educational activities, contract questions, and non-routine claim issues.
• Coordinate communications on administrative and medical policy, reimbursement, and provider utilization patterns.
• Conduct proactive outreach to support the understanding of managed care policies and procedures, as well as various initiatives and programs.
• Participate in external Provider Townhalls/Seminars and attend State Association conferences (e.g., MGMA, AFP, AAP, HFMA).
• Identify and report on provider utilization patterns that impact the quality of service delivery.
• Research issues that may impact future provider contract negotiations or jeopardize network retention.

• Requires a Bachelor’s degree.
• Minimum of 3 years of customer service experience, including 2 years in a healthcare or provider environment.
• Or any combination of education and experience which provides an equivalent background.
• Excellent oral, written, and interpersonal communication skills.
• Strong problem-solving, facilitation, and analytical skills.
• Ability to travel as required.
• The Medicaid Provider Relationship Account Manager position may involve a mix of on-site and remote working environments based on the organization’s policies and the specific requirements of the job.