Provider Relations/Services AE I [ Cincinnati, OH ]
Company: AmeriHealth Caritas
Posted on: August 7, 2022
Provider Relations/Services AE I [ Cincinnati, OH ]Location:
Primary Job Function: Provider Network
ID: 21783Job BriefMust Live In/Near: Cincinnati, OH. Medicaid
Manage Care related credentialing, claims, provider
training/education, healthcare and provider services
Your career starts now. Were looking for the next generation of
health care leaders.
At AmeriHealth Caritas, were passionate about helping people get
care, stay well and build healthy communities. As one of the
nation's 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, wed like to hear
Headquartered in Philadelphia, 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 .This role is eligible for a $2,000 sign-on
bonusResponsibilities:+ The Provider Relations/Services Account
Executive I is responsible for building, nurturing and maintaining
positive working relationships between Plan and its contracted
+ Assigned provider accounts may include single or multiple
practices in single or multiple locations, integrated delivery
systems or other provider organizations.
+ AE I maintains in depth understanding of Plans contracts and
provider performance and needs, identifying, developing and
conducting relevant and tailored provider orientation sessions,
making educational visits and working to resolve provider
+ Responsible for monitoring and managing provider network by
assuring appropriate access to services throughout the Plans
territory in keeping w/ State and Federal contact mandates for all
+ Identifies, contacts and actively solicits qualified providers to
participate in Plan at new and existing service areas and products,
assuring financial integrity of the Plan is maintained and contract
management requirements are adhered to, including language, terms
and reimbursement requirements.
+ Maintains 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 performance and
measuring ongoing performance.
+ Uses data to develop and implement methods to improve
+ 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 complains
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
+ Maintains and delivers accurate, timely activity and metric
reports as required.
+ Identifies and maintains strong partnerships with appropriate
internal resources and stakeholders.Education/ Experience:+
+ 1 to 3 years experience in a Provider Services position working
+ 3 to 5 years experience in the managed care/health insurance
+ Medicaid experience preferred.
+ Demonstrated strength in working independently, establishing
influential relationships internally and externally, meeting and
training facilitation skills, priority setting and problem solving
+Must reside in or nearby Cincinnati,Ohio._Key words: Must have
credentialing, claims, provider training/education, healthcare and
provider services experience._EOE Minorities/Females/Protected
Keywords: AmeriHealth Caritas, Cincinnati , Provider Relations/Services AE I [ Cincinnati, OH ], Other , Cincinnati, Ohio
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