Account Executive

About the Company

AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience delivering 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. As one of the nation's leaders in health care solutions, we provide opportunities to impact the lives of millions through our national footprint of products, services, and award-winning programs.

About the Role

The Account Executive is responsible for developing strong relationships with providers to drive performance, particularly with core providers in fee-for-service programs, including PCPs, OB/GYNs, high-volume specialists, and FQHCs. This role supports network development, provider satisfaction, education, and communication while maintaining positive working relationships between the Plan and its contracted providers.

For 100% remote or hybrid roles, access to a reliable high-speed internet connection with a minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Associates in states where service is contractually, legally, or regulatorily required may submit for reimbursement.

Responsibilities

• Support network development and network management strategies.
• Assist the Leader with departmental activities related to provider satisfaction, education, and communication.
• Contribute to SCA Strategy.
• Build, nurture, and maintain positive working relationships between the Plan and its contracted providers.
• Resolve provider disputes in a timely and compliant manner.
• Service assigned provider accounts, which may include single or multiple practices, locations, integrated delivery systems, or other provider organizations.
• Use data to develop and implement methods to improve relationships.
• Perform site visits as needed.
• Maintain a functional working knowledge of the provider database and relay updates about additions, deletions, or corrections.
• Identify and maintain strong partnerships with internal resources and stakeholders.
• Demonstrate operational knowledge related to provider satisfaction, education, and communication, including claims, payment integrity, provider data, credentialing, and appeals disputes.
• Maintain an in-depth understanding of the Plan’s contracts, provider performance, and needs; conduct tailored provider orientation sessions, educational visits, and issue resolution.
• Assist with recruiting providers to address identified network adequacy gaps (high complexity).
• Support contracting for multiple product lines, including LTSS, Exchange, and DSNP; may complete straightforward FFS contracts.
• Support value-based care (VBC) relationships and negotiations as needed.

Requirements

• Associate Degree required or 1+ years of experience as an Account Executive.
• Bachelor’s Degree preferred.
• One (1) or more years of relevant experience.
• Strong communication skills for delivering provider education, training, and onboarding to large groups.

Benefits

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