What are the responsibilities and job description for the Provider Network Account Executive II position at AmeriHealth Caritas?
Job Summary
The Provider Network Account Executive II (AE II)will service the Washington DC-metro area. This role is responsible for developing the strategic direction and management of theday-to-daynetwork management activities for all provider types, including single or multiple practices in single or multiple locations, integrated delivery systems, or other provider organizations. AE IIthoroughly understands the Plan’s contracts and provider performance and needs,identifies, develops, and conducts relevant and tailored provider orientation sessions, makes educationalvisits, and works to resolve provider issues. Responsible for monitoring and managing provider network by assuringappropriate accessto services throughout the Plan’s territory and keeping w/ State and Federal contact mandates for all products. Identifies, contacts, and activelysolicitsqualified providers toparticipatein the Plan at new and existing service areas and products, assuring the financial integrity of the Plan ismaintained and contract management requirements are adhered to, 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 performance and measure ongoing performance. Uses data to develop and implement methods to enhancerelationships. Assistsin corrective actionsrequiredup to and including termination, following Plan policies and procedures. Supports the Quality Management department with credentialing and re-credentialing processes, investigating membercomplaints and any 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 deliversaccurate,timelyactivity and metric reports asrequired. Identifiesandmaintainsstrong partnerships withappropriate internalresources and stakeholders.
Work Arrangement
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules.
Your career starts now. We are looking for the next generation of health care 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.
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.
AmeriHealth Caritas associates are eligible to participate in our annual incentive program and will also receive our benefits package, consisting of medical, vision, dental, life insurance, disability insurance, 401(k), paid time off and more.
The targeted hiring range for this role is expected to be between 82,200 and 112,000.
The Provider Network Account Executive II (AE II)will service the Washington DC-metro area. This role is responsible for developing the strategic direction and management of theday-to-daynetwork management activities for all provider types, including single or multiple practices in single or multiple locations, integrated delivery systems, or other provider organizations. AE IIthoroughly understands the Plan’s contracts and provider performance and needs,identifies, develops, and conducts relevant and tailored provider orientation sessions, makes educationalvisits, and works to resolve provider issues. Responsible for monitoring and managing provider network by assuringappropriate accessto services throughout the Plan’s territory and keeping w/ State and Federal contact mandates for all products. Identifies, contacts, and activelysolicitsqualified providers toparticipatein the Plan at new and existing service areas and products, assuring the financial integrity of the Plan ismaintained and contract management requirements are adhered to, 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 performance and measure ongoing performance. Uses data to develop and implement methods to enhancerelationships. Assistsin corrective actionsrequiredup to and including termination, following Plan policies and procedures. Supports the Quality Management department with credentialing and re-credentialing processes, investigating membercomplaints and any 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 deliversaccurate,timelyactivity and metric reports asrequired. Identifiesandmaintainsstrong partnerships withappropriate internalresources and stakeholders.
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
- Recruit providers as needed to ensure the realization of network adequacy targets.
- Initiates and maintains effective communication channels with internal stakeholders, including but not limited to Claims Operations Medical Management—Credentialing, Legal, Analytics departments, Compliance, Sales, and Marketing.
- Creates agreements that meet internal operational standards and external provider expectations. Ensures theaccurateimplementation and administration through internal stakeholders.
- Assistsin resolving elevated and complex provider service complaints. Research problems and negotiate with internal/external stakeholders/customers to resolvehighly complex or escalated issues.
- Responsible foraccurateandtimelycontract loading and submissions and interfacing with internal stakeholders for network implementation and maintenance.
- Manages an ongoing Provider Network Management organization project or program.
- Will develop/implement/manage programs and projects that support/impact high dollar and memberprovider groups.
- Participatingin or independently developing and implementing Provider Network education programs and materials (both internal and provider-targeted) and is assigned to train, mentor, and support new AEs. The AE II willassistAE I’s in resolving/managing issues with Providers.
- Bachelor’s Degreerequired.
- Medicaid experienceis required.
- Demonstrated experience with payment methodologies and network management experience for various provider types.
- Experience with Provider Contracting and Contract Negotiations
- Knowledge of Value-Based Contracting and Dental Contracting is highly desired.
- Minimum of 3 years of experiencein a Provider Services position working with providers to include network management and networkrecruitment
- Extensive knowledge of claims processing / billing is a plus
- Minimum of 5 years of experiencein the managed care/health insurance industry with demonstrated strengths in knowledge of Plan policies and procedures related to provider contracting, provider credentialing, provider billing and payment, provider incentive programs, and other essential State and Federal regulatory requirements related to providers, claim adjudication systems, provider file database requirements and relevant software applications; working independently and managing complex projects and programs both as an independent owner and team leader, training and mentoring skills, interacting at an executive level internally and externally.
- Minimum of 5 years of substantive Account Executive experience with high impact, high dollar, extremely visible, and critical provider groups.
- Valid driver’s license and automobile insuranceare required.
- Candidates will be servicing the Washington DC Metropolitan area.
- Self-starter and natural problem solver.
- Highlyeffective communicator, comfortable with public speaking – the ideal candidate will have experience presenting to leadership and executive teams.
- Ability to build relationships thatnurture provider partnerships and seek broader value-based business opportunities to support the local market strategy.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules.
Your career starts now. We are looking for the next generation of health care 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.
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.
AmeriHealth Caritas associates are eligible to participate in our annual incentive program and will also receive our benefits package, consisting of medical, vision, dental, life insurance, disability insurance, 401(k), paid time off and more.
The targeted hiring range for this role is expected to be between 82,200 and 112,000.