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 from you.Headquartered in Newtown Square, 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 .Responsibilities:;The Dental Account Executive will support the Philadelphia region, including Bucks, Delaware, Montgomery, and Chester counties. The Dental Account Executive is responsible for building, nurturing, and maintaining positive working relationships between Plans and its’ contracted or subcontracted fully delegated vendor providers for all dental-connected products, including Medicaid and Medicare, for the benefit of the membership. ;The Dental Account Executive is also the point person responsible for working with providers, delegated providers, vendors, and members to increase the membership’s covered utilization of the plans. ; The dental account executive makes education visits in person and virtually, facilitates local outreach sessions, functions as a proactive plan account leader, and coordinates the resolution of member and provider issues with internal partners and the vendor.;
Functions as a liaison between Plans and the participating AHC providers by responding to their needs and inquiries, educating providers and their office staff, and/or suggesting such activities by vendors when dealing with a fully delegated network.
Functions as an account leader for assigned providers and manages the dental office's needs in an AHC network and through the vendor in a delegated market.
Work directly with the vendor to ensure provider data accuracy and apply appropriate claims processing guidelines.
Collaborates to resolve system issues and understand and utilize the vendor's systems and reporting capabilities.
Advocate for members to access covered care by plan at AHC providers or through fully delegated network providers.
Serves as a backup to the Dental Program Manager as needed for Plan representation.
Works closely with the Medical Account Executive to manage the FQHC dental sites in AHC territories.
Supports the Quality Management Department with the credentialing and re-credentialing process and the investigation of member complaints.
Works with all departments to develop and execute strategies for optimally managing medical costs.
Assist with achieving quality and health plan objectives through accomplishing provider initiatives.
Maintains knowledge of Plan policies and procedures related to provider contracting, credentialing, provider billing and payment, physician and hospital incentive programs, Plan provider file database requirements, and other key State and Federal regulatory requirements relating to providers. ;Maintains proficiency in the Plan claim adjudication system.
;Education/Experience:;
Bachelor’s Degree or equivalent combination of education and work experience.
Minimum of 3 years in the managed care/health insurance industry.
1 to 2 years Medicaid experience preferred.
Minimum of 1 year in a ;Dental Provider Services position.
Previous experience working with dental/healthcare providers.
Previous dental provider relations experience preferred.
Valid driver’s license and current auto insurance.
Diversity, Equity, and InclusionAt Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.We keep our associates happy so they can focus on keeping our members healthy.Our Comprehensive Benefits PackageFlexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.