Provider Engagement Account Manager (Northeast PA)

Location: Remote in Pennsylvania, covering Lackawanna, Luzerne, Lycoming, Monroe, Columbia, Schuylkill, and Northumberland counties; local travel required 4 days per week

Salary: $56,200–$101,000 per year

Company

hirify.global connects people with healthcare services through health plans and provider networks.

What you will do

• Serve as the primary contact and liaison for contracted providers and the health plan.
• Triage, investigate, resolve, and communicate provider-related issues, including claims and demographic changes.
• Educate providers on referrals, claims submission, website usage, EDI, policies, and procedures.
• Conduct provider orientations and maintain orientation materials.
• Manage network performance through consultative account management and evaluate provider performance.
• Develop and execute improvement plans focused on risk/P4Q, HBR, HEDIS, quality, cost, and utilization.

Requirements

• Bachelor’s degree in a related field or equivalent experience.
• At least two years of experience in managed care, medical groups, provider relations, quality improvement, claims, contracting, utilization management, or clinical operations.
• Project management experience in a medical group, IPA, or health plan setting.
• Proficiency with HEDIS and quality measures, cost, and utilization.
• Must be authorized to work in the United States without current or future employment-based visa sponsorship.
• Local travel is required four days per week across the assigned Northeast Pennsylvania territory.

Culture & Benefits

• Work focused on improving healthcare access and outcomes for individuals, families, and communities.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Flexible work arrangements across remote, hybrid, field, and office schedules.
• Equal opportunity workplace committed to diversity and inclusion.