Experience Inc. Jobs

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 hear from 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.

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. ;

Responsibilities:;

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 credentialing and re-credentialing processes, investigating member complaints, and addressing 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.

• Those most complex have a higher number of multiple practice locations, multi-specialty practices, multiple providers, and an extensive health system.

• Those that impact a total member population of a minimum of 5,000 or more will focus on quality and population health initiatives.;

• Each plan determines the appropriate minimum number of member population impacts for the Provider Services AE I level according to its business environment.

• Develop, implement, and manage programs and projects that support/impact high-dollar and member-provider groups.

• Responsible for participating in or independently developing and implementing Provider Network education programs and materials (internal and provider targeted) and assigned to train, mentor, and support new AEs.;

• Assist AE I in resolving/managing issues with providers.

;Education & Qualifications:

• A bachelor’s degree or equivalent experience is required.

• High School diploma required.

• 3 to 5 years of experience in a provider services position working with providers.

• 5 to 10 years of experience in the managed care or health insurance industry with demonstrated strengths in knowledge of Plan policies and procedures related to provider complaint resolution, provider credentialing, provider billing and payment, provider incentive programs, and other essential State and Federal regulatory requirements related to providers, claim adjudication systems, provider file database requirements and relevant software applications.

• Working independently and managing complex projects and programs both as an independent owner and team leader, training and mentoring skills, interacting at an executive level internally and externally.;;

• Substantive Account Executive experience with high impact, high dollar, extremely visible, and critical provider groups.

• This position requires travel within the Central Ohio counties.

• A valid driver’s license and automobile insurance are required.;

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 and hybrid work schedules, competitive pay, paid time off, including holidays and volunteer events, health insurance coverage for you and your dependents on day one, 401(k) tuition reimbursement, and more.