AmeriHealth Caritas · 13 hours ago
Provider Network Account Executive II
Washington, DC
Full-time
Onsite
Mid, Senior Level
$82K/yr - $112K/yr
5+ years expAmeriHealth Caritas is a mission-driven organization with over 30 years of experience in delivering comprehensive, outcomes-driven care. The Provider Network Account Executive II is responsible for managing provider network activities, developing strategic relationships, and ensuring compliance with contractual obligations while supporting quality management processes.
Health CareInformation Technology
Responsibilities
Self-starter and natural problem solver
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 and interfacing with internal stakeholders for network implementation and maintenance
The AE II manages an ongoing Provider Network Management organization project or program
Will develop/implement/manage programs and projects that support/impact high dollar and member provider groups
The AE II is responsible for participating in or independently developing and implementing Provider Network education programs and materials (both internal and provider-targeted) and is assigned to train, mentor, and support new AEs. The AE II will assist AE I’s in resolving/managing issues with Providers
Qualification
Required
Bachelor's Degree required
Demonstrated experience with payment methodologies and network management experience for various provider types
Experience with Provider Contracting and Contract Negotiations
3-5 years experience in a Provider Services position working with providers to include network management and network recruitment
5-10 years experience in the managed care/health insurance industry with demonstrated strengths in 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; working independently and managing complex projects and programs both as an independent owner and team leader, training and mentoring skills, interacting at an executive level internally and externally
5-10 years of substantive Account Executive experience with high impact, high dollar, extremely visible, and critical provider groups
Medicaid experience is required
Valid driver's license and automobile insurance are required
Preferred
Knowledge of Value-Based Contracting is highly desired
Knowledge of Dental Contracting is highly desired
Extensive knowledge of claims processing / billing is a plus
Benefits
Flexible work solutions including remote options, hybrid work schedules.
Medical
Vision
Dental
Life insurance
Disability insurance
401(k)
Paid time off
Company
AmeriHealth Caritas
AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill.
10001+ employees
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)
Funding
Current Stage
Late StageLeadership Team
Kathleen Giblin
SVP Clinical Operations
Ash Hanson
Executive Vice President & Chief Human Resources Officer
Recent News
2025-11-06
The Philadelphia Inquirer
2025-10-02
2025-10-01
Company data provided by crunchbase