Provider Relations Representative
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 contracts providers and essential vendors, supports network coverage, and ensures providers meet credentialing requirements. The role educates providers about the Health Plan’s functions, policies, and goals, maintains provider relationships, and participates in implementation and process improvement. The position requires travel to network provider locations. Teleworking may be available if criteria are met. Work hours are 8 a.m. to 5 p.m. local time.
Requirements
- Experience in the health care field.
- Knowledge of and familiarity with all levels of medical services, and the 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.
- Bachelor’s degree.
- Availability to work from 8 a.m. to 5 p.m. local time.
- Willingness and ability to travel to network provider locations.
Nice To Haves
- Prior experience in network development or network services.
- Prior experience with acute and post-acute facilities.
- Prior experience with Medicare Advantage plans.
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 on 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 presentations to ensure providers understand and commit to the Health Plan’s programs.
- 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.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
