Role Overview

The Provider Network Account Executive II is a self-starter and natural problem solver with strong communication skills, including experience presenting to leadership and executive teams. They are responsible for building and nurturing relationships to support local market strategies and value-based businesses. This role involves recruiting providers to meet network adequacy targets and maintaining effective communication with internal departments such as Claims Operations, Medical Management, Credentialing, Legal, Analytics, Compliance, Sales, and Marketing. The Account Executive II drafts and manages provider agreements that align with internal standards and provider expectations, ensuring accurate implementation through stakeholder collaboration. They handle complex and escalated provider service issues, negotiate resolutions, and provide timely contract submissions and network maintenance. Additionally, Account Executive II manages ongoing provider network projects and develops programs that impact high-value providers and large member groups. They also play a key role in creating and delivering provider education programs, mentoring new account executives, and supporting Account Executive I in resolving provider-related issues.

Work Arrangement

• This hybrid position will require in-office work in our District of Columbia office

• Travel throughout the District of Columbia area will be required

Experience and Education

• Demonstrated experience with payment methodologies and network management experience for various provider types
• Experience with Provider Contracting and Contract Negotiations
• Minimum of 3 years experience in a Provider Services position working with providers to include network management and network recruitment 
• Minimum of 5 years experience in the managed care/health insurance industry with demonstrated strengths in  knowledge of Plan policies and procedures related to provider contracting, 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
• Minimum of 5 years of substantive Account Executive experience with high impact, high dollar, extremely visible, and critical provider groups
• Medicaid experience is required
• Bachelor Degree required

Licensure

• A valid driver’s license and automobile insurance are required

Skills & Abilities

• Knowledge of Value-Based Contracting is highly desired
• Knowledge of Dental Contracting is highly desired
• Extensive knowledge of claims processing/billing is a plus 

At AmeriHealth Caritas, we are 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 would like to connect with 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.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules.

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. AmeriHealth Caritas associates are eligible to participate in our annual incentive program and will also receive our benefits package, consisting of medical, vision, dental, life insurance, disability insurance, 401(k), paid time off and more. The targeted hiring range for this role is expected to be between $78,200 and $106,600.