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 healthcare 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 onboarding and educational sessions; resolve issues to support provider engagement and satisfaction.
• Monitor network adequacy and ensure compliance with state and federal access standards across all product lines.
• Identify and recruit qualified providers in new and existing service areas, ensuring alignment with financial and contractual requirements.
• Analyze provider performance using Plan reports and metrics; develop 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 outcomes.
• 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, Medicaid, or ACA Exchange preferred.

Skills & Abilities

• Ability to establish and maintain trust-based partnerships with healthcare 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 within internal departments.

Our Comprehensive Benefits Package

We offer flexible work solutions, including remote options and hybrid schedules, competitive pay, 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 AmeriHealth Caritas, we’re 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 millions of lives through our national footprint of products, services, and award-winning programs. If you want to make a difference, we’d love to hear from you.

Headquartered in Newtown Square, PA, 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. 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