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 delivering comprehensive healthcare solutions. The Provider Network Account Executive I will be responsible for building relationships with healthcare providers and ensuring they have the necessary resources to deliver exceptional care to members.

Responsibilities

• Serve as the primary liaison between the Plan and assigned providers, ensuring a thorough understanding of contract terms, provider needs, and performance expectations
• Conduct tailored provider onboarding and educational sessions; resolve issues to support provider engagement and satisfaction
• Monitor network adequacy and ensure compliance with state and federal access standards across all product lines
• Identify and recruit qualified providers in new and existing service areas, ensuring alignment with financial and contractual requirements
• Analyze provider performance using Plan reports and metrics; develop and implement improvement strategies based on data insights
• Support corrective action processes, including provider terminations, in accordance with Plan policies
• Collaborate with the Quality Management team on credentialing, re-credentialing, member complaints, and quality-of-care investigations
• Maintain accurate provider data in Facets and coordinate updates with the Provider Maintenance Department
• Prepare and submit timely reports on activities, metrics, and outcomes
• Build and sustain effective partnerships with internal departments and stakeholders

Skills

• High school diploma/GED
• 1–3 years of experience in a Provider Services role working directly with providers
• 3–5 years of experience in the managed care or health insurance industry
• Ability to establish and maintain trust-based partnerships with healthcare providers and internal teams
• Strong problem-solving skills to manage and de-escalate provider concerns with professionalism and diplomacy
• Self-starter with excellent time management skills and the ability to work independently
• Skilled at balancing competing demands across provider accounts, projects, and deadlines
• Effective collaboration with cross-functional teams within internal departments
• Bachelor's degree or equivalent experience
• Experience with Medicare, Medicaid, or ACA Exchange

Benefits

• Flexible work solutions, including remote options and hybrid schedules
• Competitive pay
• Paid time off (including holidays and volunteer events)
• Health insurance coverage for you and your dependents starting Day 1
• 401(k)
• Tuition reimbursement

Company Overview

Company H1B Sponsorship