Provider Network Account Executive

Account Executive I

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:

• Hybrid - Associate must be in the office at least three (3) days per week at our Manchester, New Hampshire (NH) location, including core days of Tuesdays and Wednesdays.
• The position requires 20% to 30% travel in New Hampshire.

Responsibilities:

• Understand and manage the Plan's contracts and provider performance, conduct tailored orientation sessions, educational visits, and resolve issues.
• Ensure appropriate access to services across the Plan's territory in compliance with state and federal mandates.
• Identify, contact, and solicit qualified providers to join the Plan, ensuring financial integrity and adherence to contract requirements.
• Utilize plan reports and metrics to evaluate provider performance, communicate improvement plans, and foster stronger relationships.
• Assist in implementing corrective actions, including termination, as per the Plan policies.
• Aid in credentialing, re-credentialing, investigating member complaints, and addressing quality issues.
• Maintain knowledge of Facets and relay information about provider changes to the Provider Maintenance Department.
• Deliver accurate and timely activity and metric reports.
• Build strong partnerships with internal resources and stakeholders.

Education & Experience:

• Bachelor's degree or equivalent experience, high school diploma/GED required.
• 1 to 3 years in provider services
• 3 to 5 years in managed care/health insurance.
• Experience with Medicare, Medicaid, or Exchange, behavioral health, contract negotiations, value-based contracting, and provider auditing.

Licensure:

• Must have a valid driver's license and car insurance.

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.

As a company, we support internal diversity through: Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.