Provider Account Executive

Summary

AmeriHealth Caritas is a mission-driven healthcare solutions organization focused on helping people access care and build healthy communities. The Provider Account Executive develops and maintains relationships with healthcare providers, supports network development and contracting, resolves provider disputes, delivers education, and conducts provider outreach and site visits throughout South Carolina.

Responsibilities

• Supports network development and network management strategies
• Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication
• Assist in SCA Strategy
• Responsible for building, nurturing, and maintaining positive working relationships between Plan and its contracted providers
• Resolve Provider disputes in a timely and compliant manner
• Servicing assigned provider accounts which may include single or multiple practices in single or multiple locations, integrated delivery systems or other provider organizations
• Uses data to develop and implement methods to improve relationship
• Perform site visits as needed
• Maintains a functional working knowledge of Facets, including the provider database and routinely relays information about additions, deletions or corrections
• Identifies and maintains strong partnerships with appropriate internal resources and stakeholders
• General Operational Knowledge related to provider satisfaction, education and communication with a fundamental understanding of operational items such as claims, payment integrity, provider data, credentialing, appeals disputes etc
• Maintains in depth understanding of Plan’s contracts and provider performance and needs, identifying, and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues
• Assist with recruiting providers based on identified network adequacy gaps (high complexity)
• Support contracting for multiple product lines, including LTSS, Exchange, DSNP could be asked to complete straightforward FFS contracts
• Support of VBC relationships and negotiations where needed
• Remote, field-based position requiring regular travel throughout assigned regions in South Carolina. Candidates residing in or near Greenville, Aiken, or Charleston Counties are strongly preferred
• Conduct provider outreach, relationship management, education, training, onboarding, and on-site provider visits within the designated service areas
• Valid driver's license, current automobile insurance, and reliable personal transportation are required

Skills

• Remote, field-based position requiring regular travel throughout assigned regions in **South Carolina.**
• Valid driver's license, current automobile insurance, and reliable personal transportation are required
• High school diploma or GED required
• Equivalent combination of education and relevant experience will be considered
• Minimum of **1-3 years of Provider Services experience** working directly with healthcare providers
• Demonstrated experience delivering **provider education, training, onboarding, and presentations to large groups**
• Minimum of **3-5 years of experience in the managed care, health insurance, or healthcare industry**
• Experience building and maintaining effective provider relationships
• Strong presentation, facilitation, and public speaking skills
• Ability to educate providers on policies, procedures, regulatory requirements, and operational processes
• Excellent communication, organizational, and customer service skills
• Candidates residing in or near **Greenville, Aiken, or Charleston Counties** are strongly preferred
• Bachelor's degree preferred
• Knowledge of and experience supporting **Medicare, Medicaid, and/or Affordable Care Act (ACA) Exchange programs** preferred
• Proficiency with Microsoft Office applications and provider-facing systems preferred

Qualifications

Must Haves

• Remote, field-based position requiring regular travel throughout assigned regions in **South Carolina.**
• Valid driver's license, current automobile insurance, and reliable personal transportation are required
• High school diploma or GED required
• Equivalent combination of education and relevant experience will be considered
• Minimum of **1-3 years of Provider Services experience** working directly with healthcare providers
• Demonstrated experience delivering **provider education, training, onboarding, and presentations to large groups**
• Minimum of **3-5 years of experience in the managed care, health insurance, or healthcare industry**
• Experience building and maintaining effective provider relationships
• Strong presentation, facilitation, and public speaking skills
• Ability to educate providers on policies, procedures, regulatory requirements, and operational processes
• Excellent communication, organizational, and customer service skills

Nice to Haves

• Candidates residing in or near **Greenville, Aiken, or Charleston Counties** are strongly preferred
• bachelor's degree preferred
• Knowledge of and experience supporting **Medicare, Medicaid, and/or Affordable Care Act (ACA) Exchange programs** preferred
• Proficiency with Microsoft Office applications and provider-facing systems preferred

Benefits

• Flexible work solutions, including remote options and hybrid schedules
• Paid time off, including holidays and volunteer events
• Health insurance coverage for you and your dependents starting Day 1
• 401(k)
• Tuition reimbursement