Provider Network Account Executive I

Position Overview

Your career starts now at AmeriHealth Caritas – a mission-driven organization dedicated to helping people get care, stay well, and build healthy communities. As one of the nation’s leaders in healthcare solutions with more than 30 years of experience, we offer our associates the opportunity to make a real impact on the lives of millions through our comprehensive products, services, and award-winning programs.

The Provider Services AE I role is responsible for building, nurturing, and maintaining positive working relationships between the Plan and its key contracted providers. This position involves conducting tailored provider orientation sessions, making educational visits, resolving provider issues, and using data-driven insights to evaluate and improve provider performance. You will collaborate closely with internal stakeholders, support quality management processes, and help drive initiatives focused on quality and population health.

Location: Newtown Square

Key Responsibilities

• Build and maintain positive working relationships between the Plan and its contracted providers, which may include single or multiple practices, health systems, integrated delivery systems, or other provider organizations.
• Develop an in-depth understanding of the Plan's contracts and provider performance, and conduct tailored provider orientation sessions and educational visits.
• Ensure provider perspectives and feedback are integrated into evaluations of improvement initiatives while collaborating to remove administrative barriers.
• Utilize Plan reports and metrics to evaluate provider performance, determine improvement plans, and implement strategies to enhance ongoing performance.
• Leverage data to develop methods that improve provider relationships and overall outcomes.
• Assist in corrective actions up to and including termination by following Plan policies and procedures.
• Support the Quality Management department with credentialing, re-credentialing, investigating member complaints, and addressing quality issues.
• Maintain a functional working knowledge of Facets, including the provider database, and communicate required updates to the Provider Maintenance Department.
• Provide accurate and timely activity and metric reports as required.
• Identify and cultivate strong partnerships with internal resources and stakeholders.
• Manage complex provider accounts, including those with multiple practice locations, multi-specialty practices, and extensive health systems, with a focus on quality and population health initiatives.
• Develop, implement, and manage programs and projects for high-dollar and member-provider groups.
• Participate in and/or independently develop provider network education programs and materials to train, mentor, and support new Account Executives.
• Assist the AE I in resolving and managing issues with providers.

Required Qualifications

• Education: A bachelor's degree or equivalent experience is required.
• High School diploma required.
• Experience Required: 1 to 3 years of experience in a provider services position working with providers.
• Experience Required: 3 to 5 years of experience in the managed care or health insurance industry with proven knowledge of Plan policies and procedures related to provider complaint resolution, credentialing, billing and payment, incentive programs, and regulatory requirements.
• Ability to work independently and manage complex projects as both an individual owner and team leader, with strong training, mentoring, and executive-level interaction skills.
• Substantive Account Executive experience with high-impact, high-dollar, and critical provider groups.
• Must have a valid driver's license and automobile insurance.
• Willingness to travel within the following counties in Ohio: Van Wert, Allen, Mercer, Auglaize, Hardin, Wyandot, Marion, Crawford, Marrow, Richland, Ashland, Knox, Wayne, Holmes, Coshocton, Tuscarawas, Stark, Carroll, Harrison, Jefferson, Columbiana, Ashtabula, Geauga, Lake, Trumbull, Portage, Mahoning, and Columbiana.

Benefits & Perks

• Benefits: Flexible work solutions, including remote options and hybrid work schedules.
• Benefits: Competitive pay.
• Benefits: Paid time off, including holidays and volunteer events.
• Benefits: Health insurance coverage for you and your dependents starting on day one.
• Benefits: 401(k) and tuition reimbursement.
• And more.