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AmeriHealth Caritas · 5 days ago

Provider Network Account Executive I

United States

Full-time

Remote

Entry Level

3+ years exp

AmeriHealth Caritas is a mission-driven organization delivering comprehensive healthcare solutions. The Provider Network Account Executive I is responsible for building and maintaining relationships with contracted providers, ensuring access to services, and supporting provider performance through education and metrics evaluation.

Health CareInformation Technology

H1B Sponsor Likely

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

Qualification

Provider Services experienceManaged care experienceMedicare experienceMedicaid experienceTraining facilitation skillsProblem-solving skillsRelationship building

Required

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

Demonstrated strength in working independently, establishing influential relationships internally and externally, meeting and training facilitation skills, priority setting, and problem-solving skills

Preferred

Medicare, Medicaid, or ACA Exchange experience preferred

Benefits

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.

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)