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AmeriHealth Caritas · 2 months ago

Provider Network Account Executive I

Hialeah, FL

Full-time

Hybrid

Entry, Mid Level

3+ years exp

AmeriHealth Caritas is seeking a detail-oriented and relationship-driven Account Executive I to manage and support their network of contracted healthcare providers. The role involves building partnerships, conducting orientations, resolving issues, and ensuring compliance with access requirements while monitoring provider performance and supporting credentialing processes.

Health CareInformation Technology

H1B Sponsor Likely

Responsibilities

Serve as the primary liaison between the Plan and assigned providers, ensuring a deep understanding of contract terms, provider needs, and performance expectations

Conducted tailored provider onboarding and educational sessions, and issued resolutions to support provider engagement and satisfaction

Monitor network adequacy and ensure compliance with state and federal access standards across all product lines

Identify and recruit qualified providers in new and existing service areas, ensuring alignment with financial and contractual requirements

Analyze provider performance using Plan reports and metrics; develop and implement improvement strategies based on data insights

Support corrective action processes, including provider terminations, by Plan policies

Collaborate with the Quality Management team on credentialing, re-credentialing, member complaints, and quality of care investigations

Maintain accurate provider data in Facets and coordinate updates with the Provider Maintenance Department

Prepare and submit timely reports on activities, metrics, and outcomes

Build and sustain effective partnerships with internal departments and stakeholders

Qualification

Provider Services experienceManaged care experienceProvider data managementBilingual in SpanishRelationship managementTime managementCross-functional collaboration

Required

A high school diploma/GED

1 to 3 years of experience in a Provider Services position working with providers

3 to 5 years of experience in the managed care/health insurance industry

Experience in provider data management, including maintaining accurate provider records and databases

Must have a valid driver's license and car insurance

Preferred

A bachelor's degree or equivalent experience

Medicare, Medicaid, Commercial, or ACA Exchange experience

Bilingual in Spanish to support diverse provider populations

Company

AmeriHealth Caritas

Glassdoor3.4

AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill.

Founded in 1982

Philadelphia, Pennsylvania, USA

10001+ employees

http://www.amerihealthcaritas.com

H1B Sponsorship

AmeriHealth Caritas has a track record of offering H1B sponsorships. Please note that this does not guarantee sponsorship for this specific role. Below presents additional info for your reference. (Data Powered by US Department of Labor)

Distribution of Different Job Fields Receiving Sponsorship

Represents job field similar to this job

Trends of Total Sponsorships

2025 (18)

2024 (17)

2023 (12)

2022 (14)

2021 (4)

2020 (11)