Provider Network Remote Jobs in Silver Spring, MD

Work Arrangement:

This position is a 4 days / week hybrid position in our DC office located at 1201 Maine SW.

Job Summary

The primary responsibility of 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.

Essential Functions:

• Supports network development and network management strategies.
• Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication.
• Assist in same case agreement 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 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.

Education/Experience:

• Associate's Degree required or a minimum of 1 year of experience as an Account Executive; Bachelor's Degree preferred

• Strong communications skills, would need to deliver provider education, training, and onboarding to large groups.

The targeted hiring range for this role is expected to be between 71,600.00 and 97,500.00. The range displayed in this job posting reflects the minimum and maximum for new hire salaries for the position in the Washington D.C. area. Within the range, individual pay is determined by additional factors, including, without limitation, job-related skills, experience, and relevant education, certifications, or training.

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.

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's 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’d like to hear from 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.