[Remote] Senior Account Executive

Note: The job is a remote job and is open to candidates in USA. AmeriHealth Caritas is hiring a Senior Account Executive to develop and maintain provider relationships and improve performance in value-based arrangements and health system contracts. The role supports network development, provider satisfaction and education, contract implementation, quality reviews, and resolution of provider issues.

Responsibilities

• Supports network development and network management strategies
• Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication
• Responsible for participating in and implementing Provider Network education programs and materials (both internal and provider targeted) and is assigned to train, mentor and support new Account Executives
• Responsible for hospital and physician network development and management; including joint operating committees (JOC) for identified groups, oversight of necessary quality review meetings with targeted providers and/or health systems
• Responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers; including those that are most complex
• Resolve Provider disputes in a timely and compliant manner
• Responsibility for a higher number of multiple practice locations and multi-specialty practices and multiple providers. Should also include hospital systems, contracted subcontractors (DME, Vision, etc.), and ancillary providers
• Develop/implement/manage programs and projects that support/impact high dollar and high member provider groups
• Perform site visits as needed
• Oversee resolution of provider issues managed by other Provider Network support teams
• Take corrective actions required up to and including termination, following Plan policies and procedures
• Operationalizes completed contracts with advanced complexity
• Consults on VBC contracts, facilitates for success (JOCs, performance overview, etc.) with specific bonuses attached to performance improvement
• Responsible to maintain and manage Value-Based contract requirements, including but not limited to; monitoring performance standards against VBC or State program requirements, working with key stakeholders and provide oversight on applicable data-sharing or report requirements
• Responsible for hospital and physician network development and management; including JOC for identified groups, oversight of necessary quality review meetings with targeted providers and/or health systems
• 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
• Support contracting for multiple product lines, including LTSS, Exchange, DSNP adequacy gaps (high complexity)
• Assist with recruiting providers based on identified network adequacy gaps (high complexity)
• Support of VBC negotiations; lead in VBC relationships; may lead negotiations

Skills

• Associate's degree required or 5 plus years as an Account Executive experience
• 7 years of experience if no bachelor's degree
• 5 or more years strong communication skills, financial acumen, ability to have difficult conversations
• 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
• Bachelor's degree preferred

Benefits

• Remote work; associate must reside in Louisiana and attend site visits to providers and in-office meetings in Baton Rouge.

Company Overview

Company H1B Sponsorship