Position Overview: The Provider Network Account Executive II (AE II) is responsible for developing strategic direction and managing day-to-day network activities for all provider types, including single or multiple practices, integrated delivery systems, and other provider organizations. This role involves understanding the Plan’s contracts and provider performance, conducting tailored orientation sessions, educational visits, and resolving provider issues. The AE II ensures appropriate access to services across the Plan’s territory, adhering to State and Federal mandates for all products.

Key Responsibilities:

• Monitor and manage the provider network to ensure service accessibility and compliance with mandates.
• Provide risk adjustment reporting training to providers. Monitor and analyze risk adjustment performance.
• Identify, contact, and solicit qualified providers to join the Plan, maintaining financial integrity and contract requirements.
• Use plan reports and metrics to evaluate and improve provider performance.
• Develop methods to enhance provider relationships and assist in corrective actions as needed.
• Assist with credentialing, re-credentialing, and investigating member complaints and quality issues.
• Maintain knowledge of Facets and relay provider database updates to the Provider Maintenance Department.
• Deliver accurate, timely activity and metric reports.
• Build strong partnerships with internal resources and stakeholders.
• Highly effective communicator, comfortable with public speaking and presenting to leadership and executive teams.
• Nurture provider partnerships and seek value-based business opportunities to support local market strategy.
• Recruit providers to meet network adequacy targets.
• Resolve complex provider service complaints and negotiate solutions.
• Ensure accurate contract loading and submissions, and manage network implementation and maintenance.
• Manage ongoing projects or programs within the Provider Network Management organization.
• Develop and implement provider education programs and materials, and train new AEs.
• Assist AE I in managing provider issues.

Education & Experience:

• Bachelor's degree required.
• 5 to 10 years of substantive Account Executive experience with high-impact provider groups
• 3 to 5 years in Provider Services, including network management and recruitment
• 5 to 10 years of managed care/health insurance and Medicaid experience.
• Extensive knowledge of claims processing/billing, risk adjustment, and data analytics is required.;;
• Knowledge of policies and procedures related to provider contracting, credentialing, billing, payment, incentive programs, and other essential State and Federal regulatory requirements related to providers, claim adjudication systems, file database requirements, and relevant software applications.
• Working independently and managing complex projects and programs
• Ability to train and mentor team members by offering guidance and support, while fostering a collaborative and productive work environment.
• Communicate effectively with executives to provide updates, insights, and recommendations on key projects and initiatives.
• Travel: Required within the state of Michigan.;
• Driver’s License: Valid driver’s license and automobile insurance required.

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