Provider Engagement Account Manager (Healthcare)

Location: Remote in Tennessee, supporting the lower half of West Tennessee and Shelby County; local travel is required 4 days per week.

Salary: $56,200–$101,000 per year

Company

hirify.global provides health plan services designed to connect people with accessible and effective healthcare.

What you will do

• Serve as the primary contact and liaison for contracted healthcare providers and the health plan.
• Triage and resolve provider issues, including claims issues, demographic changes, and operational requests.
• Educate providers on referrals, claims submission, website usage, EDI, policies, and procedures.
• Conduct provider orientations and maintain orientation and education materials.
• Manage network performance through consultative account management and develop strategic improvement plans.
• Drive improvements in risk and pay-for-quality performance, HEDIS and quality measures, 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 live in Tennessee and be able to travel locally four days per week.

Culture & Benefits

• Health insurance, 401(k), stock purchase plans, tuition reimbursement, paid time off, and holidays.
• Flexible remote, hybrid, field, or office work schedules may be available depending on the role and eligibility.
• Full-time employment with compensation adjusted for skills, experience, education, and other job-related factors.
• Equal opportunity workplace committed to diversity and inclusion.