Provider Network Account Executive I

AmeriHealth Caritas • Charleston, SC

253d

About The Position

The Provider Network Account Executive I (AE I) is responsible for building, nurturing, and maintaining positive working relationships between the Plan and its contracted providers. Assigned provider accounts may include single or multiple practices in single or multiple locations, integrated delivery systems, or other provider organizations.

Requirements

• A bachelor's degree or equivalent experience required.
• A high school diploma/GED required.
• 1 to 3 years experience in a Provider Services position working with providers.
• 3 to 5 years experience in the managed care/health insurance industry.
• Medicare, Medicaid, or Exchange experience required.
• Demonstrated strength in working independently, establishing influential relationships internally and externally, meeting and training facilitation skills, priority setting, and problem-solving skills.

Nice To Haves

• Behavioral health experience is strongly preferred.
• Contract negotiations, value-based contracting, and provider auditing experience preferred.

Responsibilities

• Maintains an in-depth understanding of the Plan's contracts and provider performance and needs, identifying, developing, and conducting relevant and tailored provider orientation sessions, making educational visits, and resolving provider issues.
• Monitor and manage the provider network by assuring appropriate access to services throughout the Plan's territory through state and federal contact mandates for all products.
• Identifies, contacts, and actively solicits qualified providers to participate in the Plan in new and existing service areas and products, assuring the financial integrity of the Plan and adhering to contract management requirements, including language, terms, and reimbursement requirements.
• Maintains a complete understanding of Plan reports and metrics and uses them to evaluate the performance of assigned providers/practices/facilities, determining, communicating, and implementing plans for providers to improve and measure ongoing performance.
• Uses data to develop and implement methods to enhance relationships.
• Assists in corrective actions required up to and including termination, following Plan policies and procedures.
• Supports the Quality Management department with credentialing and re-credentialing processes, investigating member complaints, and addressing potential quality issues.
• Maintains a functional working knowledge of Facets, including the provider database, and routinely relays information about additions, deletions, or corrections to the Provider Maintenance Department.
• Maintains and delivers accurate, timely activity and metric reports as required.
• Identifies and maintains strong partnerships with appropriate internal resources and stakeholders.

Benefits

• Flexible work solutions include remote options, hybrid work schedules.
• Competitive pay.
• Paid time off.
• Holidays and volunteer events.
• Health insurance coverage for you and your dependents on Day 1.
• 401(k) tuition reimbursement.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree