Provider Network Account Executive II
To see similar active jobs please follow this link: Remote Management jobs
Job Brief
Provider Network Account Executive II. Must have expertise in Value-Based Contracting & proven Medicare/Medicaid and/or ACA background. Remote only to qualified residents in/near Eastern, NC. (Greenville, NC highly preferred). Up to 25% travel required.
Your career starts now. We are looking for the next generation of healthcare leaders.
At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare 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 connect with 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.
To Qualify Must Live in/near Eastern North Carolina
(Greenville, Goldsboro, Wilson, or Rocky Mount)
Position Overview
The Provider Network Account Executive II is a critical role bridging the health plan and its provider network in Eastern North Carolina. This position emphasizes building and maintaining strong provider relationships, ensuring contractual compliance, driving performance improvements, and managing high-impact accounts such as complex multi-location practices. Responsibilities include leading provider education, resolving issues, supporting credentialing and quality management processes, and ensuring network accessibility aligns with state and federal mandates. This role combines strategic thinking, problem-solving, and data-driven decision-making to optimize outcomes for members and enhance provider satisfaction. Collaboration with internal teams, effective use of technical systems, and monitoring key metrics are central to ensuring the financial integrity and operational success of the provider network.
Qualifications and Requirements
- Bachelor’s degree or equivalent education and experience is required.
- Remote to candidates who currently reside in Eastern North Carolina (i.e., Greenville, Goldsboro, Wilson, and Rocky Mount) and travel up to 25%.
- 5-10 years of experience in managed care or health insurance, with expertise in Medicaid, Medicare, and/or ACA Exchange programs.
- Demonstrated success managing provider network value-based contracts and high-dollar, multi-specialty practices.
- Strong background in quality management, including credentialing, re-credentialing, investigating complaints, and addressing quality issues.
- Proficiency in claims adjudication systems, provider file databases, and relevant software applications, particularly Facets.
- Ability to ensure accurate provider data by relaying updates to the Provider Maintenance Department and managing database corrections.
- Experience implementing corrective actions, ensuring compliance with regulatory mandates, and delivering provider education sessions.
- Proven ability to analyze performance metrics, implement improvement plans, and achieve measurable results.
- Strong communication, leadership, and project management skills, with experience mentoring peers and leading high-visibility initiatives.
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 include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement, and more.
#HM
About the job
Provider Network Account Executive II
To see similar active jobs please follow this link: Remote Management jobs
Job Brief
Provider Network Account Executive II. Must have expertise in Value-Based Contracting & proven Medicare/Medicaid and/or ACA background. Remote only to qualified residents in/near Eastern, NC. (Greenville, NC highly preferred). Up to 25% travel required.
Your career starts now. We are looking for the next generation of healthcare leaders.
At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare 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 connect with 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.
To Qualify Must Live in/near Eastern North Carolina
(Greenville, Goldsboro, Wilson, or Rocky Mount)
Position Overview
The Provider Network Account Executive II is a critical role bridging the health plan and its provider network in Eastern North Carolina. This position emphasizes building and maintaining strong provider relationships, ensuring contractual compliance, driving performance improvements, and managing high-impact accounts such as complex multi-location practices. Responsibilities include leading provider education, resolving issues, supporting credentialing and quality management processes, and ensuring network accessibility aligns with state and federal mandates. This role combines strategic thinking, problem-solving, and data-driven decision-making to optimize outcomes for members and enhance provider satisfaction. Collaboration with internal teams, effective use of technical systems, and monitoring key metrics are central to ensuring the financial integrity and operational success of the provider network.
Qualifications and Requirements
- Bachelor’s degree or equivalent education and experience is required.
- Remote to candidates who currently reside in Eastern North Carolina (i.e., Greenville, Goldsboro, Wilson, and Rocky Mount) and travel up to 25%.
- 5-10 years of experience in managed care or health insurance, with expertise in Medicaid, Medicare, and/or ACA Exchange programs.
- Demonstrated success managing provider network value-based contracts and high-dollar, multi-specialty practices.
- Strong background in quality management, including credentialing, re-credentialing, investigating complaints, and addressing quality issues.
- Proficiency in claims adjudication systems, provider file databases, and relevant software applications, particularly Facets.
- Ability to ensure accurate provider data by relaying updates to the Provider Maintenance Department and managing database corrections.
- Experience implementing corrective actions, ensuring compliance with regulatory mandates, and delivering provider education sessions.
- Proven ability to analyze performance metrics, implement improvement plans, and achieve measurable results.
- Strong communication, leadership, and project management skills, with experience mentoring peers and leading high-visibility initiatives.
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 include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement, and more.
#HM