Provider Network Account Executive II
- Fayetteville, NC
- Permanent
- Full-time
- Remote - Associate can work remotely anywhere in North Carolina, but will be servicing Cumberland County and surrounding counties in North Carolina.
- Travel – 50% travel in Cumberland County, North Carolina
- Monitor and manage the provider network to ensure service accessibility and compliance with mandates.
- Identify, contact, and solicit qualified providers to join the Plan, maintaining financial integrity and contract requirements.
- Use plan reports and metrics to evaluate and improve provider performance
- Develop methods to enhance provider relationships and assist in corrective actions as needed
- Assist with credentialing, re-credentialing, and investigating member complaints and quality issues
- Maintain knowledge of Facets and relay provider database updates to the Provider Maintenance Department
- Deliver accurate, timely activity and metric reports
- Build strong partnerships with internal resources and stakeholders
- Highly effective communicator, comfortable with public speaking and presenting to leadership and executive teams
- Nurture provider partnerships and seek value-based business opportunities to support local market strategy
- Recruit providers to meet network adequacy targets
- Resolve complex provider service complaints and negotiate solutions
- Ensure accurate contract loading and submissions, and manage network implementation and maintenance
- Manage ongoing projects or programs within the Provider Network Management organization
- Develop and implement provider education programs and materials, and train new AEs
- Support of Value-Based Contracting (VBC) negotiations; lead in VBC relationships; may lead negotiations
- Consults on VBC contracts, facilitates success (JOCs, performance overview, etc.) with specific bonuses attached to performance improvement
- Responsible for maintaining and managing VBC requirements, including but not limited to: monitoring performance standards against VBC or State program requirements, working with key stakeholders, and providing oversight on applicable data-sharing or report requirements
- Assist AE I in managing provider issues
- A bachelor's degree or equivalent education and experience are required.
- High School Diploma/GED required
- 3 to 5 years of contract negotiation experience preferred.
- 3 to 5 years of value-based care experience preferred.
- 3 to 5 years of experience working with Health Systems in a Provider Services position.
- 5 to 10 years of experience in the managed care/health insurance industry, with strengths in provider complaint resolution, credentialing, billing and payment, incentive programs, regulatory requirements, claim adjudication systems, and relevant software applications.
- Experience with high-impact, high-dollar, critical provider groups.
- Medicaid experience is required; DSNP and ACA Exchange experience is preferred.
- A driver’s license and car insurance are required.
- Ability to work independently and manage complex projects and programs.
- Skills in training and mentoring Account Executives.
- Experience interacting at an executive level internally and externally.