Posted on: June 10, 2021
This position is responsible for supporting AmeriHealth Caritas
providers in the counties of Lehigh, Northampton, Carbon, and
Schuylkill . Experience with claims and billing is required along
with contract negotiation experience.
Your career starts now. We’re looking for the next generation of
health care leaders.
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 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, we’d 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 www.amerihealthcaritas.com.
The AE I is responsible for building, nurturing and maintaining
positive working relationships between Plan and its contracted
providers. 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 Plan’s contracts and provider
performance and needs, identifying, developing and conducting
relevant and tailored provider orientation sessions, making
educational visits and working to resolve provider issues.
Responsible for monitoring and managing provider network by
assuring appropriate access to services throughout the Plan’s
territory in keeping w/ State and Federal contact mandates for all
products. 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 relationship. 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 Department. Maintains and delivers
accurate, timely activity and metric reports as required.
Identifies and maintains strong partnerships with appropriate
internal resources and stakeholders.
This position will support
the following counties; Lehigh, Northampton,
Carbon, and Schuylkill.
1 to 3 years experience in a Provider Services
position working with
3 to 5 years experience in the managed care/health
Medicaid experience preferred.
Demonstrated strength in working independently, establishing
influential relationships internally and externally, meeting and
training facilitation skills, priority setting and problem solving
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