Provider Relations Account Executive
Location: Queens, NY
Job Type: Direct Placement
Company: ARC Group
Category: Administration
Job Description Apply Now
The Provider Relations Account Executive plays a pivotal role in fostering strong partnerships between managed care organizations and contracted provider networks. This position is fundamental in ensuring the delivery of high-quality, value-based healthcare to members. The Provider Relations Account Executive serves as the liaison between the health plan and medical providers, utilizing strategic engagement and data-driven insights to enhance provider performance, address challenges, and promote best practices in patient care.
This full-time position emphasizes the importance of building and maintaining trusted relationships with physicians and healthcare administrators. The Provider Relations Account Executive is responsible for regularly visiting providers to discuss performance metrics, share actionable feedback, and identify opportunities for improvement in clinical practices. The role requires expertise in value-based care models, with a focus on aligning provider incentives to achieve superior patient outcomes, cost efficiency, and improved quality of care.
Key responsibilities include leveraging data analytics to monitor provider performance, facilitating performance improvement initiatives, and collaborating with providers to meet organizational goals. The Provider Relations Account Executive also acts as a resource for education on company policies, claims processes, and the use of electronic data interchange (EDI) tools. This role involves resolving provider issues, investigating claim concerns, and ensuring that providers receive timely and effective support.
The Provider Relations Account Executive is also tasked with presenting detailed Health Benefit Ratio (HBR) analyses and preparing reports for Joint Operating Committee meetings, contributing to strategic decision-making. As a leader within the team, the Provider Relations Account Executive provides coaching and training to external representatives, fostering a collaborative environment that supports both internal and external stakeholders.
Travel is a significant aspect of this position, with frequent local visits required to maintain strong provider relationships and ensure real-time support. The Provider Relations Account Executive must comply with all organizational policies, procedures, and standards, and demonstrate a commitment to continuous improvement and professional development.
Provider Relations Account Executive - Summary- Acts as a strategic partner between health plans and provider networks, ensuring the highest standards of care for members
- Focuses on value-based performance, provider engagement, and relationship management
- Utilizes data analytics to drive provider performance and support quality improvement initiatives
- Serves as a lead resource and coach for external representatives
- Supports company mission to transform community health outcomes
- Develop strategic partnerships with contracted provider networks to enhance care delivery
- Conduct frequent in-person visits with physicians to discuss performance metrics and improvement strategies
- Collaborate on value-based care initiatives, aligning provider incentives with organizational goals
- Use data analytics to monitor and optimize provider performance
- Resolve provider-related issues and support claims processes with timely communication
- Educate providers on company policies, procedures, and EDI tools
- Present HBR analyses and prepare detailed performance reports for committee meetings
- Lead, coach, and train external representatives to ensure cohesive team performance
- Travel locally to maintain strong provider relationships and offer on-site support
- Comply with all company policies, standards, and regulatory requirements
- Perform additional duties as assigned to support department goals
- Competitive salary with potential for annual performance-based bonus
- Comprehensive benefits package including health insurance, retirement plans, and stock purchase options
- Tuition reimbursement and paid time off, including holidays
- Flexible work arrangements with remote, hybrid, field, or office work schedules
- Compensation adjusted based on skills, experience, education, and job-related factors
- Bachelor’s degree in a related field or equivalent experience required
- Master’s degree in Public Health (MPH), Health Administration (MHA), or Business Administration (MBA) preferred
- Minimum 3-5 years of experience in managed care, provider relations, quality improvement, utilization management, or clinical operations
- Project management experience within a medical group, IPA, or health plan setting
- Demonstrated ability to influence outcomes and drive provider engagement at executive level
- Strong knowledge of HEDIS/Quality measures, cost, and utilization analytics
- Valid driver’s license required; ability to travel locally as needed
- Exceptional interpersonal, communication, and analytical skills
- Proven track record in developing provider relationships and driving performance improvement initiatives
- Experience conducting face-to-face performance metrics discussions with healthcare providers
- Expertise in value-based care models and performance-based agreements
- Skilled at synthesizing complex issues and collaborating across multi-disciplinary teams
- Adaptable, solutions-focused, and committed to continuous professional growth
- Working in this area offers opportunities to engage with a diverse healthcare community and make a tangible impact on public health
- No relocation or sponsorship options available for this position
- Centene is an equal opportunity employer committed to diversity and inclusion
- Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws
If you are a strategic thinker with a passion for provider engagement and healthcare quality, apply now by clicking the job application button to join our team as a Provider Relations Account Executive. Bring your expertise and help us make a meaningful difference in the health of our communities.