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

Role Overview: The Provider Network Account Executive (AE II) is responsible for building, nurturing, and maintaining positive working relationships between AmeriHealth Caritas North Carolina (ACNC) and its contracted providers. This role involves managing provider accounts, including 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.

;Work Arrangement:

• Remote - Associate can work remotely anywhere in North Carolina, but will be servicing Cumberland County and surrounding counties in North Carolina.; ;;
• Travel – 50% travel in Cumberland County, North Carolina

;Responsibilities:

• Monitor and manage the provider network to ensure service accessibility and compliance with mandates.
• Identify, contact, and solicit qualified providers to join the Plan, maintaining financial integrity and contract requirements.
• Use plan reports and metrics to evaluate and improve provider performance
• Develop methods to enhance provider relationships and assist in corrective actions as needed
• Assist with credentialing, re-credentialing, and investigating member complaints and quality issues
• Maintain knowledge of Facets and relay provider database updates to the Provider Maintenance Department
• Deliver accurate, timely activity and metric reports
• Build strong partnerships with internal resources and stakeholders
• Highly effective communicator, comfortable with public speaking and presenting to leadership and executive teams
• Nurture provider partnerships and seek value-based business opportunities to support local market strategy
• Recruit providers to meet network adequacy targets
• Resolve complex provider service complaints and negotiate solutions
• Ensure accurate contract loading and submissions, and manage network implementation and maintenance
• Manage ongoing projects or programs within the Provider Network Management organization
• Develop and implement provider education programs and materials, and train new AEs
• Support of Value-Based Contracting (VBC) negotiations; lead in VBC relationships; may lead negotiations
• Consults on VBC contracts, facilitates success (JOCs, performance overview, etc.) with specific bonuses attached to performance improvement
• Responsible for maintaining and managing VBC requirements, including but not limited to: monitoring performance standards against VBC or State program requirements, working with key stakeholders, and providing oversight on applicable data-sharing or report requirements
• Assist AE I in managing provider issues

;Education & Experience:

• A bachelor's degree or equivalent education and experience are required.
• High School Diploma/GED required
• 3 to 5 years of contract negotiation experience preferred.
• 3 to 5 years of value-based care experience preferred.
• 3 to 5 years of experience working with Health Systems in a Provider Services position.
• 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; DSNP and ACA Exchange experience is preferred.

;Licensure:

• A driver’s license and car insurance are required.;

;Skills & Abilities:

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

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.

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