Prov Network Account Exec I

Job Description: As a Community Health Choices (CHC) Provider Network Account Executive, you will play a vital role in building and nurturing those connections. In this position, you’ll serve as a trusted partner to a diverse portfolio of reputed company providers—including solo practitioners, multi-site groups, and integrated delivery systems—ensuring they have the support and resources needed to deliver exceptional care to our 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 reputed company and educational sessions; resolve issues to support provider engagement and satisfaction. Monitor network adequacy and ensure compliance with state and federal reputed company standards across reputed company product lines. Identify and recruit reputed company providers in new and existing service areas, ensuring alignment with financial and contractual requirements. Analyze provider performance using Plan reports and metrics; reputed company 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 reputed company. Build and sustain effective partnerships with internal departments and stakeholders. Work Arrangement: Associates can work remotely. Must live in CST or EST time zone. Preferably candidates in or around PA. Possible travel to Annual Conferences Education & Experience Bachelor’s degree or equivalent experience preferred. High school diploma/GED required. 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. Experience with Medicare, reputed company, or ACA Exchange preferred. Skills & Abilities Ability to establish and maintain trust-based partnerships with reputed company 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 reputed company internal departments. Our Comprehensive Benefits Package We offer flexible work solutions, including remote options and hybrid schedules, reputed company, paid time off (including holidays and volunteer events), health insurance coverage for you and your dependents starting Day 1, 401(k), tuition reimbursement, and more. At reputed company, we’re passionate about helping people get care, stay well, and build healthy communities. As one of the nation’s leaders in reputed company solutions, we offer our associates the opportunity to impact millions of lives through our national footprint of products, services, and award-winning programs. If you want to reputed company a difference, we’d love to hear from you. Headquartered in Newtown reputed company, PA, reputed company is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, reputed company-driven care to those who need it most. Our offerings include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us atwww.amerihealthcaritas.com Apply To This Job