[Remote] Sr Account Executive

Note: The job is a remote job and is open to candidates in USA. AmeriHealth Caritas is a mission-driven organization with over 30 years of experience in healthcare solutions. They are seeking a Senior Account Executive to develop strong relationships with providers, driving performance related to risk-based and cost-sharing arrangements as well as managing large health system contracts.

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 and implementing Provider Network education programs and materials (both internal and provider targeted) and is assigned to train, mentor and support new AE’s
• 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 joint operating committees (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
• Seven years' experience if no bachelor's degree
• Five (5) or more years strong communication skills
• Financial acumen
• Ability to have difficult conversations
• Bachelor's Degree preferred

Benefits

• 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

Company Overview