What are the responsibilities and job description for the Provider Network Account Executive I position at AMERINC?
Role Overview
The AE I is responsible for fostering and maintaining positive relationships between the Plan and its contracted providers. This includes managing accounts that may span single or multiple practices, locations, integrated delivery systems, or other provider organizations.
Work Arrangement
- Remote
- Must reside in South Carolina
- Travel required within South Carolina
Responsibilities
- Understand and manage the Plan’s contracts and provider performance, conduct tailored orientation sessions, educational visits, and resolve issues
- Ensure appropriate access to services across the Plan’s territory in compliance with state and federal mandates
- Identify, contact, and solicit qualified providers to join the Plan, ensuring financial integrity and adherence to contract requirements
- Use Plan reports and metrics to assess provider performance, communicate improvement plans, and enhance relationships
- Assist in implementing corrective actions, including termination, as per the Plan policies
- Aid in credentialing, re-credentialing, investigating member complaints, and addressing quality issues
- Maintain knowledge of Facets and relay information about provider changes to the Provider Maintenance Department
- Deliver accurate and timely activity and metric reports
- Build strong partnerships with internal resources and stakeholders
Education and Experience
- Bachelor’s degree or equivalent experience, high school diploma/GED
- 1 to 3 years in Provider Services
- 3 to 5 years in managed care/health insurance
- Experience with Medicare, Medicaid, or Exchange, behavioral health, contract negotiations, value-based contracting, and provider auditing
Licensure
- A valid driver’s license and automobile insurance are required
Skills & Abilities
- Independent work, relationship building, training facilitation, priority setting, problem-solving
Your career starts now. We're looking for the next generation of healthcare leaders.
At AmeriHealth Caritas, we're passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare 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'd like to hear from you.
Headquartered in Newtown Square, PA, 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.
Our Comprehensive Benefits Package
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, and more.