Provider Relations Representative

Career Center • Springfield, MO

3d

About The Position

American Health Plans, a division of American Health Partners Inc., owns and operates Institutional Special Needs Plans (I-SNPs) for seniors living in long-term care facilities. In partnership with nursing home operators, its Medicare Advantage plans manage medical risk by improving patient care and reducing emergency room visits and avoidable hospitalizations. The Provider Relations Representative builds and maintains provider and vendor relationships to support network coverage and the delivery of services to plan members. The position requires travel to network provider locations. Teleworking may be an option if criteria are met. The required schedule is 8 a.m. to 5 p.m. local time.

Requirements

• Bachelor’s degree.
• Experience in the health care field.
• Knowledge and familiarity with all levels of medical services, and ability to rapidly develop working relationships.
• Ability to accept instructions and work independently to complete goals and assignments.
• Strong negotiation, organization, presentation, and time-management skills.
• Ability to communicate effectively with all levels of medical staff to explain Health Plan programs, benefits, and goals.
• Ability to work effectively in a team environment.
• Excellent computer skills, including Microsoft Office Suite.
• Self-motivated, dependable, team-oriented, and goal-oriented.
• Availability to work from 8 a.m. until 5 p.m. local time.
• Ability to travel to network provider locations.

Nice To Haves

• Prior experience in network development or network services is preferred.
• Prior experience with acute and post-acute facilities is beneficial.
• Prior experience with Medicare Advantage plans is helpful.

Responsibilities

• Contract with providers and essential vendors in current service areas to maintain CMS adequacy and ensure necessary services are available to plan members.
• Ensure providers and essential vendors meet credentialing requirements for their appropriate service lines.
• Educate providers about the Health Plan’s functions and role in caring for its membership.
• Provide ongoing educational updates as prescribed by CMS and Health Plan policies.
• Conduct provider education presentations to ensure providers understand and are committed to the Health Plan.
• Monitor, maintain, and support provider relationships to ensure network coverage in all areas.
• Participate in implementation as needed.
• Establish a positive work environment that encourages participation in process improvement and commitment to department and company success.
• Complete corporate assignments as assigned.

Benefits

• Affordable medical, dental, and vision insurance options.
• Generous paid time-off program and paid holidays for full-time staff.
• 24/7/365 access to doctors through TeleDoc.
• Optional short- and long-term disability plans.
• Employee Assistance Plan (EAP).
• 401(k) retirement accounts.
• Employee Referral Bonus Program.

What This Job Offers

• Job Type: Full-time