Provider Relations Representative

Career Center • Dallas, TX

8d

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, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. The Provider Relations Representative supports the plans by contracting with and educating providers, maintaining provider relationships and network coverage, and helping ensure providers meet credentialing requirements. The role requires travel to network provider locations. Teleworking may be available if criteria are met. The schedule is 8 a.m. to 5 p.m. local time.

Requirements

• Experience in the health care field is required.
• Bachelor’s degree.
• Knowledge of 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.
• Must be available to work 8 a.m. to 5 p.m. local time.
• Must be able 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 provide necessary services 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 roles 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 Plans.
• Monitor, maintain, and support provider relationships to ensure network coverage in all areas.
• Participate in implementation activities 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