What are the responsibilities and job description for the Provider Network Account Executive I - Must reside in Michigan position at AmeriHealth Caritas?
Responsibilities
- Maintains an in-depth understanding of the Plan’s contracts and provider performance and needs, identifying, developing, and conducting relevant and tailored provider orientation sessions, making educational visits, and resolving provider issues.
- Monitor and manage the provider network by assuring appropriate access to services throughout the Plan’s territory through state and federal contact mandates for all products.
- Identifies, contacts, and actively solicits qualified providers to participate in the Plan in new and existing service areas and products, assuring the financial integrity of the Plan and adhering to contract management requirements, 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 and measure ongoing performance.Uses data to develop and implement methods to enhance relationships.
- Assists in corrective actions required up to and including termination, following Plan policies and procedures.
- Supports the Quality Management department with credentialing and re-credentialing processes, investigating member complaints, and addressing 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 delivers accurate, timely activity and metric reports as required.
- Identifies and maintains strong partnerships with appropriate internal resources and stakeholders.
Education & Qualifications :
Diversity, Equity, and Inclusion
At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
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.
Generous paid time off and paid volunteer time off.
Employer-matched 401(k) and additional non-elective contributions, starting on day one.
Medical, dental, and vision plans — with coverage starting on day one.
Employee assistance programs, fitness reimbursements, nutrition counseling, and more.
Employer-paid life insurance, with opportunities to purchase additional coverage.
Employer-paid short-term disability coverage and long-term disability coverage.
Tuition assistance, including reduced tuition at certain schools.
Financial assistance with adoption, including paid time off.
Flexible spending and health savings accounts to pay for qualified expenses.
Discount programs on entertainment, travel, and more.
