Provider Network Account Executive

Job Description

Job Description

• This position offers a hybrid work schedule, requiring employees to work in the office four days a week and one day remotely

Company Overview :

As one of the Washington Metropolitan-area’s fastest growing IT companies, we are always looking for creative, passionate and responsible employees. We acknowledge that intelligent, dedicated employees are our greatest asset and are continuously adding to our talented and diverse team. If you feel innovation, integrity and a drive to deliver are key components to success, we invite you to become Enlightened.

Position Overview :

The Provider Network Account Executive is responsible for building, nurturing, and maintaining positive working relationships between the 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. The Network Account Executive maintains an in-depth understanding of the Plan’s contracts, provider performance, and needs, identifying, developing, and conducting relevant and tailored provider orientation sessions, making educational visits, and working to resolve provider issues.

The role is responsible for monitoring and managing the provider network by ensuring appropriate access to services throughout the Plan’s territory, in keeping with State and Federal contact mandates for all products. This includes identifying, contacting, and actively soliciting qualified providers to participate in the Plan in new and existing service areas and products, ensuring the financial integrity of the Plan is maintained and contract management requirements are adhered to, including language, terms, and reimbursement requirements.

The Provider Network Account Executive maintains a complete understanding of the Plan’s reports and metrics and uses them to evaluate the performance of assigned providers, practices, and facilities, determining, communicating, and implementing plans for providers to improve performance and measuring ongoing performance. The Executive uses data to develop and implement methods to improve relationships and assists in corrective actions required, up to and including termination, following Plan policies and procedures.

Additionally, the Executive supports the Quality Management department with the credentialing and re-credentialing processes, investigation of member complaints, and any potential quality issues. They maintain a functional working knowledge of Facets, including the provider database, and routinely relay information about additions, deletions, or corrections to the Provider Maintenance Department. The Executive also maintains and delivers accurate, timely activity and metric reports as required, and identifies and maintains strong partnerships with appropriate internal resources and stakeholders.

Position Responsibilities :

Required Qualifications :

Knowledge, Skills, and Abilities

Benefits :

The expected salary range for this position is listed above. Actual compensation will be determined based on experience and qualifications as well as internal equity and alignment with market data.

At Enlightened, we pride ourselves on offering a comprehensive and industry-competitive benefits package to our full-time employees. Our benefits include :

Please note, these benefits are available exclusively to full-time employees of Enlightened.

Enlightened is proud be an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.