Provider Engagement Account Manager

Location: Remote within Florida; candidates must live in Miami-Dade County. Local travel to Miami and surrounding areas is required 4 days per week.

Salary: $56,200–$101,000 per year

Company

hirify.global provides health plan services designed to improve access to care and health outcomes for individuals, families, and communities.

What you will do

• Serve as the primary contact and liaison for contracted healthcare providers and the health plan.
• Triage, investigate, resolve, and communicate provider-related issues, including claims issues and changes.
• Manage provider network performance through a consultative account management approach.
• Evaluate provider performance and develop improvement plans covering risk, quality, cost, and utilization.
• Educate providers on policies, referrals, claims submission, website usage, and EDI-related topics.
• Conduct provider orientations, maintain educational materials, and complete special projects.

Requirements

• Must live in Florida within Miami-Dade County.
• 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 in HEDIS and quality measures, cost, and utilization.
• Ability to travel locally four days per week.

Culture & Benefits

• Work supporting healthcare access and outcomes for members and communities.
• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Flexible work approaches, including remote, hybrid, field, and office schedules.
• Equal opportunity workplace committed to diversity and inclusion.