Provider Network Account Executive II

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We are looking for the next generation of healthcare leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to connect with you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Job Summary

As an Account Representative for AmeriHealth Caritas North Carolina, you will 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. Examples of providers you will work with include and may include Primary Care Physicians, OB/GYNs, high volume specialists, and Federally Qualified Health Centers (FQHC).

Work Arrangement:

• This position is required to work in our DC office located at 1201 Maine SW 4 out of 5 days a week.
• Monday through Friday, 8:30 AM to 5:00 PM

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 relationships with providers
• Perform site visits as needed.
• Maintains a functional working knowledge of 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 Value Based Care relationships and negotiations where needed.

Education/Experience:

• High School Diploma or GED required
• Bachelor’s Degree preferred
• Minimum of three years of experience in provider relations
• Experience delivering provider education, training, and onboarding to large groups
• Valid driver’s license and automobile insuranceare required.
• Candidates will be servicing the Washington DC Metropolitan area.

Skills

• Ability to cultivate and maintain relationships with internal resources and external stakeholders
• Proficiency in MS Office
• Working knowledge of provider databases and ability to analyze the data in order to develop and implement methods to improve relationships with providers
• Strong communication skills with the ability to influence stakeholders in order to create mutually beneficial agreements
• Ability to navigate complex contractual terms and conditions

The targeted hiring range for this role is expected to be between 71,600 and 97,500. The range displayed in this job posting reflects the minimum and maximum for new hire salaries for the position in the Washington D.C. area. Within the range, individual pay is determined by additional factors, including, without limitation, job-related skills, experience, and relevant education, certifications, or training.

Our Comprehensive Benefits Package

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