Provider Network Account Executive II

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 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 would like to connect with 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.

About this job: 

The AE II is responsible for building, nurturing, and maintaining positive working relationships between AmeriHealth Caritas North Carolina (AHNC) and its contracted providers. This role involves managing provider accounts, which may include single or multiple practices, integrated delivery systems, or other provider organizations. The AE II ensures provider performance and needs are met, conducts orientation sessions, makes educational visits, and resolves provider issues. The position also involves monitoring and managing the provider network to ensure appropriate access to services, maintaining financial integrity, and adhering to contract management requirements.

Key Responsibilities:

• Build and maintain positive relationships with providers, including large health systems and high-spend providers with multiple locations or specialties.
• Monitor and manage the provider network to ensure compliance with state and federal mandates, as well as appropriate access to services.
• Identify, contact, and solicit qualified providers, ensuring contract language, terms, and reimbursement requirements are met.
• Use ACNC reports and metrics to evaluate provider performance, develop improvement plans, and measure ongoing performance.
• Support credentialing and re-credentialing processes, investigate member complaints, and address potential quality issues.
• Develop and conduct provider orientation sessions, educational visits, and training programs for new AEs.
• Develop, implement, and manage ongoing Provider Network Management projects.
• Maintain strong partnerships with internal stakeholders and ensure provider database integrity using Facets.

Education & Qualifications:

• Bachelor's Degree or equivalent education and experience required.
• 3 to 5 years of contract negotiation experience preferred.
• 3 to 5 years of experience in a Provider Services position working with Health Systems.
• 5 to 10 years of experience in the managed care/health insurance industry, with strengths in provider complaint resolution, credentialing, billing and payment, incentive programs, regulatory requirements, claim adjudication systems, and relevant software applications.
• Experience with high-impact, high-dollar, critical provider groups.
• Medicaid experience is required; ACA Exchange experience is preferred.

Skills & Competencies:

• Ability to work independently and manage complex projects and programs.
• Skills in training and mentoring new AEs.
• Experience interacting at an executive level internally and externally.

Remote Work:

• This is a 100% remote position. Finalists can reside anywhere in Western North Carolina (e.g., Asheville, Hickory, Statesville).

Travel:

• Requires 50% travel to provider offices.  Candidates must have a valid driver's license, reliable car, and insurance.

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.