Note: The job is a remote job and is open to candidates in USA. AmeriHealth Caritas is a mission-driven organization dedicated to improving healthcare access and outcomes. They are seeking a Provider Network Account Executive I to develop and maintain relationships with healthcare providers, supporting network development and provider satisfaction. The role involves managing provider accounts, resolving disputes, and delivering provider education while requiring regular travel within Florida.
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
- General Operational Knowledge related to provider satisfaction, education and communication with a fundamental understanding of operational items such as claims, payment integrity, provider data, credentialing, appeals disputes etc
- 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
Skills
- High school diploma or GED required
- Minimum of 1-3 years of Provider Services experience working directly with healthcare providers
- Minimum of 3-5 years of experience in the managed care, health insurance, or healthcare industry
- Demonstrated experience delivering provider education, training, onboarding, and presentations to large groups
- Valid driver's license, current automobile insurance, and reliable personal transportation are required
- Bachelor's degree preferred
- Knowledge of and experience supporting Medicare, Medicaid, and/or Affordable Care Act (ACA) Exchange programs preferred
- Proficiency with Microsoft Office applications and provider-facing systems 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
Benefits
- Flexible work solutions, including remote options and hybrid schedules
- Paid time off (including holidays and volunteer events)
- Health insurance coverage for you and your dependents starting Day 1
- 401(k)
- Tuition reimbursement
Company Overview