• Provider Network Account Executive I

    AmeriHealth Caritas (Baton Rouge, LA)


    **Role Overview:** The Account Executive fosters and maintains positive relationships between the Plan and its contracted providers. This includes managing accounts spanning single or multiple practices, locations, integrated delivery systems, or other provider organizations.

    Work Arrangement:

    + Remote - Associate must be located in the state of Louisiana.

    Responsibilities:

    + Understand and manage the Plan’s contracts and provider performance, conduct tailored orientation sessions, educational visits, and resolve issues.

    + Ensure appropriate access to services across the Plan’s territory in compliance with state and federal mandates.

    + Identify, contact, and solicit qualified providers to join the Plan, ensuring financial integrity and contract compliance.

    + Use Plan reports and metrics to assess provider performance, communicate improvement plans, and enhance relationships.

    + As per the Plan policies, assist in implementing corrective actions, including termination.

    + Aid in credentialing, re-credentialing, investigating member complaints, and addressing quality issues.

    + Maintain knowledge of Facets and relay information about provider changes to the Provider Maintenance Department.

    + Deliver accurate and timely activity and metric reports.

    + Build strong partnerships with internal resources and stakeholders.

    Education & Experience:

    + High school diploma/GED required

    + 1 to 3 years of experience working with the provider

    + 3 to 5 years in managed care/health insurance.

    + Experience with Medicare, Medicaid, or Exchange, behavioral health, contract negotiations, value-based contracting, and provider auditing.

    Skills & Abilities:

    + Being able to work independently, build relationships, facilitate training, prioritize tasks, and solve problems.

     

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    As a company, we support internal diversity through:

    Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.