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Provider Network Account Manager Jobs in Florida

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Provider Network Account Manager information

What is the difference between Provider Network Account Manager vs Provider Relations Specialist?

AspectProvider Network Account ManagerProvider Relations Specialist
CredentialsRelevant certifications (e.g., CPC, CPCO), industry experienceSimilar certifications, focus on communication skills
Work EnvironmentHealthcare organizations, insurance companiesHealthcare providers, insurance companies
Employer & Industry UsageUsed in insurance and managed care companiesCommon in healthcare provider organizations and insurers
Primary FocusManaging provider networks, contracts, and accountsBuilding provider relationships, resolving issues

The Provider Network Account Manager primarily manages provider networks and contracts, ensuring smooth operations between providers and insurers. In contrast, the Provider Relations Specialist focuses on building and maintaining provider relationships and resolving provider concerns. While both roles require industry knowledge and similar certifications, their core responsibilities differ in scope and focus.

What does a provider network account manager do?

A provider network account manager oversees relationships between healthcare providers and insurance companies, ensuring network agreements are maintained and compliance standards are met. They coordinate contract negotiations, resolve provider issues, and analyze network performance, often using healthcare management software. Strong communication and negotiation skills are essential in this role.

What cities in Florida are hiring for Provider Network Account Manager jobs?

Cities in Florida with the most Provider Network Account Manager job openings:

Provider Relations Account Executive (IDD)

Ocala, FL • On-site

Independent Living Systems
Health Care and Social Assistance • 501 - 1,000 employees
Learn more about Independent Living Systemsexternal

Full-time

This job post has expired today. Applications are no longer accepted.

Independent Living Systems rating

6.5

Company rating: 6.5 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

Job description

We are seeking a Provider Relations Account Executive (IDD) to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Provider Relations Account Executive (IDD) plays an essential role in fostering and maintaining strong partnerships with providers who deliver services to individuals with intellectual and developmental disabilities (IDD). The Provider Relations Account Executive (IDD) is responsible for ensuring that provider networks are robust, compliant, and aligned with organizational goals to deliver high-quality care. The Provider Relations Account Executive (IDD) involves relationship management, contract negotiation, and ongoing communication to support provider satisfaction and performance. The Provider Relations Account Executive (IDD) will collaborate closely with internal teams to address provider concerns, facilitate training, and implement process improvements. Ultimately, the Provider Relations Account Executive (IDD) drives the success of the provider network, contributing to improved outcomes for individuals served and the overall growth of the health care services organization.

Minimum Qualifications:

  • Bachelor’s degree in Health Administration, Business, Social Work, or a related field or equivalent experience.
  • Minimum of 3 years of experience in provider relations, account management, or a similar role preferably within the health care services industry.
  • Knowledge of intellectual and developmental disabilities (IDD) services and related regulatory environments.
  • Experience with Contract Management.
  • Relevant experience may substitute for educational requirement on a year-for-year basis.

Preferred Qualifications:

  • Bachelor’s degree in Health Administration, Business, Social Work, or a related field.
  • Experience working specifically with IDD provider networks or in managed care environment.
  • Familiarity with Medicaid and other public health care programs related to IDD services.
  • Advanced degree or certification in health care management or a related discipline.
  • Proficiency with provider network management software and data analytics tools.
  • Demonstrated ability to lead projects and collaborate across multidisciplinary teams.

Responsibilities:

  • Develop and maintain strong, collaborative relationships with IDD service providers to ensure network adequacy and quality standards are met.
  • Facilitate the development, negotiation, and execution of provider contracts, ensuring terms meet regulatory standards and organizational policies.
  • Monitor provider performance metrics and work with providers to implement corrective action plans when necessary.
  • Serve as the primary point of contact for all assigned providers, and as a link to various départements to address inquiries, resolve disputes, and maintain positive partnerships.. 
  • Maintain accurate records of provider interactions and follow up on outstanding issues to ensure timely resolution.
  • Collaborate with cross-functional teams including care management, compliance, and finance teams to support provider network initiatives and improve service delivery.
  • Ensure high levels of provider satisfaction by providing exceptional service and support.



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