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Provider Network Account Executive II - Value Based Programs

Company: AmeriHealth Caritas
Location: Newark
Posted on: January 15, 2020

Job Description:



Provider Network Account Executive II - Value Based Programs



Location



Newark, DE



Telecommuter?



No



ID**

18402






Job BriefResponsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers



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 Philadelphia, 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.


Responsibilities:

The Provider Network Account Executive II is responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted value based providers. Assigned provider accounts may include single or multiple practices in single or multiple locations, integrated delivery systems or other provider organizations. AE II maintains in depth understanding of Plan's value based contracts and provider performance and needs, identifying, developing and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues. Identifies, contacts and actively solicits qualified providers to participate in Plan's value based programs at new and existing service areas and products, assuring financial integrity of the Plan is maintained and contract management requirements are adhered to, including language, terms and reimbursement requirements. Maintains 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 performance and measuring ongoing performance. Uses data to develop and implement methods to improve relationship. 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 II's accounts/assignments include:


  • Health systems and provider groups signed to value based purchasing agreements.

  • Those that are most complex, a higher number of multiple practice locations and multi-specialty practices and multiple providers.

  • A total practice annual pay amount over $1M.

  • 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 AE II level is determined by each Plan according to their business environments.

    The AE II is responsible for managing an ongoing Provider Network Management organization project or program.

    Will develop/implement/manage programs and projects that support/ value based initiatives.

    The AE II is responsible for participating or independently developing and implementing Provider Network education programs and materials (both internal and provider targeted) and is assigned to train, mentor and support new AE's.

    Qualifications / Education:


    • Five (5) to ten (10) years of 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 key State and Federal regulatory requirements related to providers, claim adjudication systems, provider file database requirements and relevant software applications.

    • Five (5) to ten (10) years of experience working independently and managing complex projects and programs both as an independent owner and team leader; training and mentoring skills, and the ability to interact at an executive level internally and externally.

    • Substantive Account Executive experience with high impact, high dollar, extremely visible and critical provider groups. A strong understanding of value based program metrics including HEDIS measures.

    • Bachelor's Degree.



Keywords: AmeriHealth Caritas, Newark , Provider Network Account Executive II - Value Based Programs, Other , Newark, Delaware

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