AmeriHealth Caritas Provider Network Account Executive II in Baton Rouge, Louisiana
Provider Network Account Executive II
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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
The Account Executive II (AE II) is responsible for building, nurturing and maintaining positive working relationships between PLAN and its contracted providers. The incumbent’s responsibilities include the Integrated Delivery Systems (IDS) and/or complex providers in their assigned territory. The AE II conducts provider orientation sessions, makes educational visits, and works to resolve provider issues. In addition to the Account Executive I position accountabilities, the AE II will be responsible for the orientation, training and mentoring of new Account Executives; and liaison for PLAN and other state programs. Additionally, the AE II will assume lead roles in managing special projects.
- Works with Account Executive I’s to identify and resolve issues and coordinates with Manager of Network Management to escalate concerns to appropriate parties.
- Responsible for initiating programs and reviewing data to make business decisions.
Responsible for Monitoring and Managing Provider Network by assuring appropriate access to services throughout the Plan’s territory in keeping with State contract mandates.
Identifies, contacts and actively solicits qualified providers to participate in Plan at new and existing service areas, assuring financial integrity of the Plan is maintained and Contract Management requirements are adhered to including language, terms and reimbursement requirements
- Responsible for the accuracy and timely management of the assigned territory provider contracts
- Negotiates rates for services with participating and non-participating providers and follow special pricing procedures
Functions as a liaison between PLAN and the participating provider network by responding to provider needs and inquiries, educating providers and their office staff.
Performs accurate, detailed orientations for providers within the time period specified by Department standards. Coordinates office visits with assigned Account Executive.
- Identifies topics and performs “in-services” with frequency as specified by Department standards, for providers for the purpose of communicating policy changes, orienting new staff, gathering or presenting statistical and financial data and promoting positive working relationships.
- Educates providers on all applicable incentive programs.
- Conducts service calls as requested by provider or PLAN staff member within the time period specified by Department standards.
- Addresses issues that have a negative impact on Plan’s financial status through “in-servicing” providers who demonstrate practice patterns, which are not cost-effective.
- Addresses routine inquiries without dependency on supervisor, but can distinguish those issues for which direct response is inappropriate and immediately apprises supervisor.
- Actively engages providers in Plan initiatives and/or goals.
Functions as an account leader for assigned providers.
Develops positive working relationships with applicable provider practice staff.
- Understands Plan reports and metrics and uses them to evaluate the performance of assigned practices.
- Meets with assigned practices to present data outlining their performance, promoting established performance standards.
- Develops strategies to address issues and opportunities and engages poor performing practices in meaningful dialogue to change behaviors.
- Monitors poor performing practices to ensure improvement takes place.
- Assists in corrective actions required up to and including termination, following Plan Policies & Procedures.
Coordinates the Joint Operating Committee (JOC) meeting.
Schedules meetings, manages the agenda items and maintains the meeting notes.
- Coordinates follow-up and resolution of issues identified during these meetings.
Conducts all business relationships in a professional manner and projects a professional image.
Schedules meetings at provider’s convenience demonstrating reasonable flexibility in adjusting schedule for appointments before or after normal working hours.
Supports the Quality Management Department with the credentialing and re-credentialing process, and the investigation of member complaints and potential quality Issues.
Completes requests for initial site visits within time period specified by Department standards. This includes requests for review of an existing participating physician’s new office location.
- Submits completed site visit forms to the Credentialing Department within time period specified by Department standards.
- Obtains documentation required for credentialing for credentialing or re-credentialing of providers as requested.
- Completes requests for investigation of member complaints within time period specified by Department standards.
- Identifies and reports compliance issues in accordance with Plan policy and procedure.
- Demonstrates a functionally working knowledge of Facets, including the provider database and routinely relays information about additions, deletions or corrections to the Provider Maintenance Department.
- Works with all departments to develop and execute strategies for optimally managing medical costs.
- Contributes to publication of Provider Newsletter. (i.e., reports frequently asked questions or often repeated suggestions as ideas for articles).
- Contributes to development of provider education materials in conjunction with Provider Education Consultant.
Training and leadership:
- Assists in the training and acts as a mentor for new Account Executive I’s
- Monitors assigned Account Executive I through “ride along” or like efforts at least bi-annually; provides employee performance report to Manager of Network Management regarding “ride along’s.” or like efforts, and participates in evaluation of assigned Account Executive I in collaboration with Manager of Network management
- Schedules and provides staff in-service/education at the direction of management team
- Performs other related duties and projects as assigned
- Adheres to Plan policies and procedures
- Supports and carries out the AmeriHealth Mercy Mission & Values
- Attends required training on an annual basis
- Bachelor’s degree or equivalent work experience
- Minimum 3 years experience in a Provider Services field work position
- Minimum 5 years experience in the managed care/health insurance industry
- Minimum 1 year of Medicaid experience preferred
- Valid driver’s license and current auto insurance
EOE Minorities/Females/Protected Veterans/Disabled