Job Description
Role Overview: The Account Executive is to develop strong relationships with providers to drive for performance, specifically as it relates to core providers as determined by the program who are in fee for service programs and may include PCPs, OB/GYNs, high volume specialists, and FQHCs.
Work Arrangements:
+ Remote - The associate must reside in Louisiana (LA) and attend site visits to provider and in office meetings in Baton Rouge.
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 Single Case Agreement (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 relationships.
+ Perform site visits as needed.
+ Maintains a functional working knowledge of provider databases 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 value-based contracts (VBC) relationships and negotiations where needed.
Education & Experience:
+ Associate degree required or 1 or more years as an Account Executive
+ Bachelor’s degree Preferred
+ 1 or more yearsstrong communications skills, deliver provider education, training, and onboarding to large groups.
Skills & Abilities:
+ Strong verbal and written communication skills
+ Ability to deliver provider education, training, orientation, and onboarding to large groups
+ Relationship-building and provider account management skills
+ Ability to resolve provider disputes and operational issues promptly and compliantly
+ Analytical skills, including the ability to use data to improve provider relationships and performance
+ Strong collaboration skills for working with internal stakeholders and external providers
+ Organizational skills with the ability to manage multiple provider practices, locations, or organizations
+ Proficiency in maintaining provider databases and communicating additions, deletions, and corrections
+ Ability to work independently
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.
Work Arrangements:
+ Remote - The associate must reside in Louisiana (LA) and attend site visits to provider and in office meetings in Baton Rouge.
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 Single Case Agreement (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 relationships.
+ Perform site visits as needed.
+ Maintains a functional working knowledge of provider databases 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 value-based contracts (VBC) relationships and negotiations where needed.
Education & Experience:
+ Associate degree required or 1 or more years as an Account Executive
+ Bachelor’s degree Preferred
+ 1 or more yearsstrong communications skills, deliver provider education, training, and onboarding to large groups.
Skills & Abilities:
+ Strong verbal and written communication skills
+ Ability to deliver provider education, training, orientation, and onboarding to large groups
+ Relationship-building and provider account management skills
+ Ability to resolve provider disputes and operational issues promptly and compliantly
+ Analytical skills, including the ability to use data to improve provider relationships and performance
+ Strong collaboration skills for working with internal stakeholders and external providers
+ Organizational skills with the ability to manage multiple provider practices, locations, or organizations
+ Proficiency in maintaining provider databases and communicating additions, deletions, and corrections
+ Ability to work independently
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.
Numbers & Facts
| Location | Baton Rouge, LA |
| Industry | Healthcare Services |
| Company Size | 5,000 to 9,999 employees |
| Year Founded | 1985 |
| Website | http://www.amerihealthcaritas.com |
About Company
Leaders in health care solutions for those most in need
AmeriHealth Caritas is the nation's leader in providing comprehensive health care solutions for those in most need and the chronically ill. We impact the lives of more than 5.7 million members nationwide. With more than 30 years of experience managing care for individuals and families in publicly-funded programs, we have become known for developing innovative solutions that help improve health outcomes while reducing costs.
Our mission, our goal
Our mission is to help people get care, stay well and build healthy communities. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP - plus behavioral health, pharmacy benefits management and third-party management and administrative services.
Skills
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