RPMGlobal
The Provider Network Account Executive I is responsible for building, nurturing, and maintaining positive working relationships between the Plan and its contracted providers. Assigned provider accounts may include single or multiple practices in single or multiple locations, integrated delivery systems, or other provider organizations.
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
A bachelor's degree or equivalent experience is required.
1 to 3 years experience in a Provider Services position working with providers.
3 to 5 years experience in the managed care/health insurance industry.
Medicare, Medicaid, or ACA Exchange experience preferred.
Demonstrated strength in working independently, establishing influential relationships internally and externally, meeting and training facilitation skills, priority setting, and problem-solving skills.
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 starting Day 1, 401(k) retirement savings plan, tuition reimbursement, and more.
Why Join Us 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 are driven to make a difference, we want to hear from you.
About AmeriHealth Caritas Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
#J-18808-Ljbffr
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
A bachelor's degree or equivalent experience is required.
1 to 3 years experience in a Provider Services position working with providers.
3 to 5 years experience in the managed care/health insurance industry.
Medicare, Medicaid, or ACA Exchange experience preferred.
Demonstrated strength in working independently, establishing influential relationships internally and externally, meeting and training facilitation skills, priority setting, and problem-solving skills.
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 starting Day 1, 401(k) retirement savings plan, tuition reimbursement, and more.
Why Join Us 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 are driven to make a difference, we want to hear from you.
About AmeriHealth Caritas Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
#J-18808-Ljbffr