Provider Network Account Executive I

Amerihealth Caritas•Hunters Creek, FL

5d•Remote

About The Position

The primary responsibility of Account Executive is to develop strong relationships with providers to drive for performance, specifically as it relates to core providers as determined by the program who are in fee for service programs and may include PCPs, OB/GYNs, high volume specialists, and FQHCs. This is a remote, field-based position requiring regular travel throughout assigned regions in Florida, including Lake, Orange, Osceola, Seminole, Polk, Pasco, Pinellas, and Hillsborough counties. The role involves conducting provider outreach, relationship management, education, training, onboarding, and on-site provider visits within the designated service areas. A valid driver's license, current automobile insurance, and reliable personal transportation are required.

Requirements

High school diploma or GED required
Minimum of 1-3 years of Provider Services experience working directly with healthcare providers.
Demonstrated experience delivering provider education, training, onboarding, and presentations to large groups.
Minimum of 3-5 years of experience in the managed care, health insurance, or healthcare industry.
Valid driver's license, current automobile insurance, and reliable personal transportation are required.

Nice To Haves

bachelor’s degree preferred
Equivalent combination of education and relevant experience will be considered.
Knowledge of and experience supporting Medicare, Medicaid, and/or Affordable Care Act (ACA) Exchange programs preferred.
Experience building and maintaining effective provider relationships.
Strong presentation, facilitation, and public speaking skills.
Ability to educate providers on policies, procedures, regulatory requirements, and operational processes.
Excellent communication, organizational, and customer service skills.
Proficiency with Microsoft Office applications and provider-facing systems preferred.

Responsibilities

Supports network development and network management strategies
Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication
Assist in SCA Strategy
Responsible for building, nurturing, and maintaining positive working relationships between Plan and its contracted providers
Resolve Provider disputes in a timely and compliant manner
Servicing assigned provider accounts which may include single or multiple practices in single or multiple locations, integrated delivery systems or other provider organizations
Uses data to develop and implement methods to improve relationship
Perform site visits as needed
Maintains a functional working knowledge of Facets, including the provider database and routinely relays information about additions, deletions or corrections
Identifies and maintains strong partnerships with appropriate internal resources and stakeholders
Maintains in depth understanding of Plan’s contracts and provider performance and needs, identifying, and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues
Assist with recruiting providers based on identified network adequacy gaps (high complexity)
Support contracting for multiple product lines, including LTSS, Exchange, DSNP could be asked to complete straightforward FFS contracts
Support of VBC relationships and negotiations where needed