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SalaryYour career starts now. We are looking for the next generation of health care leaders.
At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we would like to hear you.
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
Discover more about us at www.amerihealthcaritas.com.
Diversity, Equity, and Inclusion
At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
The primary purpose of the job is to:
The Provider Services AE I is responsible for building, nurturing, and maintaining positive working relationships between the Plan and its key contracted providers. Assigned provider accounts may include single or multiple practices in single or multiple locations, health systems, integrated delivery systems, or other provider organizations. Provider Services AE I maintains an in-depth understanding of the Plan’s contracts and provider performance and needs, identifying, developing, and conducting relevant and tailored provider orientation sessions, making educational visits, and resolving provider issues. Ensure that network provider perspectives and feedback are included in evaluations of improvement initiative successes; Collaborate with other ODM-contracted managed care entities to simplify provider requirements and remove administrative barriers; and develop and implement the MCO's provider claim dispute resolution process collaborate with Provider Network Operations to resolve Provider concerns timely. Maintains a complete understanding of Plan reports and metrics and uses them to evaluate the performance of assigned providers/practices/facilities, determining, communicating, and implementing plans for providers to improve and measure ongoing performance. Uses data to develop and implement methods to improve relationships. Assists in corrective actions required up to and including termination, following Plan policies and procedures. Supports the Quality Management department with the credentialing and re-credentialing processes, investigation of member complaints, and any potential quality issues. Maintains a functional working knowledge of Facets, including the provider database, and routinely relays information about additions, deletions, or corrections to the Provider Maintenance Department. Maintains and delivers accurate, timely activity and metric reports as required. Identifies and maintains strong partnerships with appropriate internal resources and stakeholders.
An AE I’s accounts/assignments include:
- Those most complex have a higher number of multiple practice locations, multi-specialty practices, multiple providers, and a large health system.
- Those that impact a total member population of a minimum of 5,000 or more.
- The appropriate minimum number of member population impact for the Provider Services AE I level is determined by each Plan according to their business environments.
- Develop, implement, and manage programs and projects that support/impact high-dollar and member-provider groups.
- Responsible for participating in or independently developing and implementing Provider Network education programs and materials (internal and provider targeted) and assigned to train, mentor, and support new AEs.
- The AE I will assist AE I’s in resolving/managing issues with Providers.
Education & Experience:
- Bachelor’s Degree or equivalent experience required.
- High School diploma required.
- Three to five years experience in a Provider Services position working with providers
- Five to ten years experience in the managed care or health insurance industry with demonstrated strengths in knowledge of Plan policies and procedures related to provider complaint resolution, provider credentialing, provider billing and payment, provider incentive programs, and other essential State and Federal regulatory requirements related to providers, claim adjudication systems, provider file database requirements and relevant software applications; working independently and managing complex projects and programs both as an independent owner and team leader, training and mentoring skills, interacting at an executive level internally and externally.
- Substantive Account Executive experience with high impact, high dollar, extremely visible, and critical provider groups.
- Ability to travel 25% within the state of Ohio in Washington, Noble, Monroe, Belmont, Guernsey, and Harrison counties.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.
