Provider Network Account Executive II

Responsibilities

The Provider Network Account Executive II (AE II) is responsible for developing the strategic direction and management of the day-to-day network management activities for all provider types, including single or multiple practices in single or multiple locations, integrated delivery systems, or other provider organizations. AE II thoroughly understands the Plan’s contracts and provider performance and needs, identifies, develops, and conducts relevant and tailored provider orientation sessions, makes educational visits, and works to resolve provider issues. Responsible for monitoring and managing provider network by assuring appropriate access to services throughout the Plan’s territory and keeping w / State and Federal contact mandates for all products. Identifies, contacts, and actively solicits qualified providers to participate in the Plan at new and existing service areas and products, assuring the financial integrity of the Plan is maintained 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 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 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 delivers accurate, timely activity and metric reports as required. Identifies and maintains strong partnerships with appropriate internal resources and stakeholders.

An AE II’s accounts / assignments include :

• Self-starter and natural problem solver.
• Highly effective communicator, comfortable with public speaking – the ideal candidate will have experience presenting to leadership and executive teams.
• Building relationships that nurture provider partnerships and seek broader value-based business opportunities to support the local market strategy.
• 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 the accurate implementation and administration through internal stakeholders.
• Assists in resolving elevated and complex provider service complaints. Research problems and negotiate with internal / external stakeholders / customers to resolve highly complex or escalated issues.
• Responsible for accurate and timely contract loading and submissions and interfacing with internal stakeholders for network implementation and maintenance.
• The AE II manages an ongoing Provider Network Management organization project or program.
• Will develop / implement / manage programs and projects that support / impact high dollar and member provider groups.
• The AE II is responsible for participating in 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 will assist AE I’s in resolving / managing issues with Providers.

Education / Experience :

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 including remote options, hybrid work schedules.

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 $78,200 and $106,600.

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.

Salary : $78,200 - $106,600