Dental Account Executive (Southeast Pennsylvania)

Philadelphia, PA, USA
Jan 12, 2019
Jan 16, 2019
Contract Type
Full Time
Job Type
Other job types
**Dental Account Executive (Southeast Pennsylvania)**

Location: Philadelphia, PA

Telecommuter?: No

ID**: 14260

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 Philadelphia, 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 .


The Dental Account Executive is responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers for all products, including : Medicaid, and Medicare The Dental Account Executive conducts orientation sessions, makes education visits, functions as a pro-active practice account leader and coordinates resolution of provider issues.

Responsible for Monitoring and Managing Provider Network by assuring appropriate access to services throughout the Southeast Pennsylvania area in keeping with State and Federal contract mandates for all products: Medicaid, Medicare and Exchange.. Identifies, contacts and actively solicits qualified providers to participate in Plan at new and existing service areas and products, assuring financial integrity of the Plan is maintained and Contract Management requirements are adhered to including language, terms and reimbursement requirements.

Negotiates rates for services with participating and non-participating providers and follow special pricing procedures

Functions as a liaison between Plan and the participating providers by responding to their needs and inquiries, and educating providers and their office staff.

+ Performs accurate, detailed orientations for assigned providers within the time period specified by Department standards.

+ Performs "in-services" within the frequency specified by Plan and State standards, for the purpose of communicating policy changes, orienting new staff, gathering or presenting statistical and financial data and promoting positive relationships.

+ Educates providers on all applicable incentive programs.

+ Conducts service calls as requested by provider or Plan staff member within the time period specified by Department standards.

+ Addresses issues that have a negative impact on Plan's financial status through "in-servicing" providers who demonstrate practice patterns which are not cost-effective.

+ Addresses routine inquiries without dependence on supervisor, but can distinguish those issues for which direct response is inappropriate and immediately apprises supervisor.

+ Liaison for claims issues between dental provider and Plan Operations.

+ Actively engages providers in Plan Initiatives and/or goals.

+ Functions as an account leader for assigned providers and manage the needs of the dental office.

+ Work directly with the vendor to ensure provider data accuracy, appropriate claims processing guidelines are applied,

+ Collaborates to resolve system issues, understand and utilize the vendor"s systems and reporting capabilities.

+ Serves as a back up to the Dental Program Manager as needed for Plan representation

+ Works closely with the Medical Account Executive to manage the FQHC dental sites.

+ Develops positive working relationships with applicable provider practice staff.

+ Understands Plan reports and metrics and uses them to evaluate the performance of assigned practices.

+ Meets with assigned practices to present data outlining their performance, promoting established performance standards

+ Develops strategies to address issues and opportunities and engages poor performing practices in meaningful dialogue to change behaviors.

+ Monitors poor performing practices to ensure improvement takes place.

+ Assists in corrective actions required up to and including termination, following Plan Policies & Procedures.

+ Supports the Quality Management Department with the credentialing and re-credentialing process, and the investigation of member complaints.

+ Supports the Dental Account Technician in credentialing or recredentialing efforts and in investigating member complaints.

+ Identifies and reports compliance issues

+ Works with all departments to develop and execute strategies for optimally managing medical costs.

+ Assist with achievement of quality and health plan objectives through accomplishment of provider initiatives.

+ Maintains knowledge of Plan policies and procedures related to provider contracting, provider 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 Plan claim adjudication system.


+ Bachelor's Degree or equivalent combination or education and work experience

+ Minimum of 3 years in the managed care/health insurance industry.

+ 1-2 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.

+ Daily travel in the 5 county area (Bucks, Chester, Delaware, Montgomery and Philadelphia) and to meet with dental providers is required for this role

EOE Minorities/Females/Protected Veterans/Disabled