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Provider Network Account Executive – 6 Month Contract
AmeriHealth Caritas. Build, nurture and maintain positive working relationships between the Plan and its contracted providers .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in provider relationship management, contract compliance, and performance improvement within the managed care and health insurance sectors. Proficient in developing and implementing provider education programs and managing complex projects while ensuring adherence to State and Federal regulations.
Highest-signal resume keywords
Provider Services ExperienceManaged Care Industry KnowledgeContract Management SkillsLeadership and Mentoring SkillsMedicaid Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Provider ContractingProvider CredentialingClaim Adjudication SystemsData Analysis in Microsoft ExcelPerformance Improvement PlansProvider Billing and PaymentProvider Incentive ProgramsProject ManagementProvider Network ManagementQuality Management Support
Soft Skills
Strong Verbal CommunicationStrong Written CommunicationDetail OrientedOrganizational SkillsProblem Solving
Tools & Technologies
Microsoft OfficeFacets Provider Database
Industry Keywords
Health InsuranceProvider NetworkState and Federal Regulatory RequirementsCommunity Health IssuesHealth and Social Service Systems
About the role
Key responsibilities & impact- Build, nurture and maintain positive working relationships between the Plan and its contracted providers
- Manage assigned provider accounts, including practices, integrated delivery systems and other provider organizations
- Maintain in-depth understanding of Plan contracts, provider performance and provider needs
- Identify, develop and conduct tailored provider orientation sessions
- Make educational visits and resolve provider issues
- Monitor and manage the provider network, assuring appropriate access to services throughout the Plan’s territory in accordance with State and Federal mandates
- Identify, contact and solicit qualified providers for participation in new and existing service areas and products
- Maintain financial integrity and contract management requirements, including language, terms and reimbursement requirements
- Use Plan reports and metrics to evaluate provider, practice and facility performance
- Develop, communicate and implement provider performance improvement plans
- Develop and implement methods to improve provider relationships using data
- Assist with corrective actions, including termination, according to Plan policies and procedures
- Support Quality Management with credentialing and re-credentialing, member complaint investigations and potential quality issues
- Maintain working knowledge of Facets, including the provider database, and relay updates to the Provider Maintenance Department
- Deliver accurate and timely activity and metric reports
- Maintain partnerships with internal resources and stakeholders
- Manage an ongoing Provider Network Management organization project or program
- Develop, implement and manage programs and projects supporting high-dollar and high-member provider groups
- Develop and implement Provider Network education programs and materials
- Train, mentor and support new Network Executives
Requirements
What you’ll need- Bachelor’s Degree
- 3 to 5 years’ experience in a Provider Services position working with providers
- 5 to 10 years’ experience in the managed care/health insurance industry
- Knowledge of Plan policies and procedures related to provider contracting, provider credentialing, provider billing and payment, provider incentive programs, State and Federal regulatory requirements related to providers, claim adjudication systems, provider file database requirements and relevant software applications
- Experience working independently and managing complex projects and programs as an independent owner and team leader
- Training and mentoring skills
- Experience interacting at an executive level internally and externally
- Substantive Account Executive experience with high impact, high dollar, extremely visible and critical provider groups
- Medicaid experience required
- Strong leadership skills and ability to navigate change
- Ability to work cross-functionally, problem solve and navigate efficiently through bureaucracy
- Working knowledge and proficiency with Microsoft Office products
- Ability to manipulate spreadsheets and data in Microsoft Excel
- Excellent listening skills
- Strong verbal and written communication skills
- Detail oriented with strong organizational and time management skills
- Self-motivated
- Scheduling, planning and follow-up skills
- Ability to interface effectively with a diverse population
- Ability to work independently and with teams
- Broad knowledge about the community, specific health issues and health and social service systems
Benefits
Comp & perks- This position is not eligible for benefits.