Top Provider Network Executive plans and directs all aspects of an organization's provider network function. Responsible for developing the network and negotiating and administering contracts. Being a Top Provider Network Executive oversees provider relations and monitors and directs all provider services. Requires a bachelor's degree. Additionally, Top Provider Network Executive typically reports to a top management. The Top Provider Network Executive manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Approves policies developed within various sub-functions and departments. To be a Top Provider Network Executive typically requires 8+ years of managerial experience. Comprehensive knowledge of the overall departmental function. (Copyright 2024 Salary.com)
At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations 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 would like to hear you.
Headquartered in Newtown Square, 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 primary purpose of the job is to:
The Provider Services AE I is responsible for building, nurturing, and maintaining positive working relationships between the Plan and its key contracted providers. Assigned provider accounts may include single or multiple practices in single or multiple locations, health systems, integrated delivery systems, or other provider organizations. Provider Services AE I maintains an in-depth understanding of the Plan’s contracts and provider performance and needs, identifying, developing, and conducting relevant and tailored provider orientation sessions, making educational visits, and resolving provider issues. Ensure that network provider perspectives and feedback are included in evaluations of improvement initiative successes; Collaborate with other ODM-contracted managed care entities to simplify provider requirements and remove administrative barriers; and develop and implement the MCO's provider claim dispute resolution process collaborate with Provider Network Operations to resolve Provider concerns timely. Maintains a 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 and measure ongoing performance. Uses data to develop and implement methods to improve relationships. Assists in corrective actions required up to and including termination, following Plan policies and procedures. Supports the Quality Management department with the credentialing and re-credentialing processes, investigation of member complaints, and any potential quality issues. 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 I’s accounts/assignments include:
Education & Experience:
Other Considerations:
Diversity, Equity, and Inclusion
At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
We keep our associates happy so they can focus on keeping our members healthy.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.