Provider Network Account Executive I

Account Executive I

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

Skills & Abilities

Licensure