- Professional
Role Overview: We’re seeking a detail-oriented and relationship-driven Account Executive I to manage and support our network of contracted healthcare providers. In this role, you’ll build and maintain strong partnerships, conduct provider orientations, resolve issues, and ensure compliance with state and federal access requirements. You’ll monitor provider performance using data and metrics, support credentialing processes, and help drive improvements in service delivery.
Work Arrangement:
- Remote – This role requires residence in South Florida and 35% travel throughout the assigned territories.
Responsibilities:
- Serve as the primary liaison between the Plan and assigned providers, ensuring a deep understanding of contract terms, provider needs, and performance expectations.
- Conducted tailored provider onboarding and educational sessions, and issued resolutions 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, by 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.
Education & Experience:
- A bachelor's degree or equivalent experience is preferred.
- A high school diploma/GED is required.
- 1 to 3 years of experience in a Provider Services position working with providers.
- 3 to 5 years of experience in the managed care/health insurance industry.
- Medicare, Medicaid, Commercial, or ACA Exchange experience preferred.
- Experience in provider data management, including maintaining accurate provider records and databases
- Bilingual in Spanish to support diverse provider populations
Skills & Abilities:
- Establish and maintain trust-based partnerships with healthcare providers and internal teams.
- Manage and de-escalate provider concerns or issues with professionalism and diplomacy.
- Take initiative, manage time effectively, and complete tasks with minimal supervision.
- Balance competing demands across provider accounts, projects, and deadlines.
- Work effectively with cross-functional teams within internal departments.
Licensure:
- Must have a valid driver’s license and car insurance.
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