Provider Network Account Executive II

Role Overview:; The Provider Network Account Executive II (AE II) strategically manages and develops provider networks across various healthcare settings, including individual practices and integrated delivery systems. This role involves ensuring compliance with state and federal regulations, conducting provider orientations and educational visits, resolving provider issues, and recruiting qualified providers to maintain adequate service coverage and financial integrity. The AE II monitors provider performance using data and metrics, implements improvement plans, and supports quality management through credentialing and issue investigations. Additionally, the role requires maintaining accurate provider data in systems like Facets, delivering timely reports, and fostering strong internal partnerships to support network operations.

Work Arrangement:

• Remote - Associate must be located in the state of Florida.
• 10 to 15% travel in the state of Florida. ;

Responsibilities:

• 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, as well as interfacing with internal stakeholders for network implementation and maintenance.
• Manages an ongoing Provider Network Management organization project or program.
• Develops, implements, and manages programs and projects that support/impact high-dollar and member provider groups.
• Participates, develops, and implements Provider Network education programs and materials (both internal and provider-targeted) and is assigned to train, mentor, and support new AEs.   
• Assist AE I in resolving/managing issues with Providers.

Education & Experience:

• A bachelor's degree or equivalent experience is required.;
• High school diploma/GED required.;
• 5 to 10 years of substantive Account Executive experience with high-impact, high-dollar, obvious, and critical provider groups.
• 3 to 5 years of experience working with providers in a Provider Services position, including network management and network recruitment.
• 5 to 10 years of experience in the managed care/health insurance industry with demonstrated strengths in the knowledge of Plan policies and procedures related to provider contracting, provider credentialing, provider billing and payment, provider incentive programs, and other essential State and Federal regulatory requirements related to providers, claim adjudication systems, provider file database requirements, and relevant software applications.
• Medicare and or Commercial experience is required.
• Extensive knowledge of claims processing/billing is a plus.
• Demonstrated experience with payment methodologies and network management for various provider types is also a plus.

Skills & Abilities:

• Working independently and managing complex projects and programs as an independent owner and team leader, training and mentoring skills, and interacting at an executive level internally and externally.

• Bilingual English/Spanish preferred.

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Our Comprehensive Benefits Package