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, the plans manage medical risk by improving patient care, reducing emergency room visits, and avoiding preventable hospitalizations. The Provider Relations Representative contracts providers and essential vendors in current service areas, supports network adequacy and coverage, and ensures providers meet credentialing requirements. The role educates providers about Health Plan functions, policies, and member care; delivers educational presentations and updates; supports provider relationships and implementation; and contributes to process improvement and company assignments. The position requires travel to provider locations. Teleworking is an option if criteria are met, and the work schedule is 8 a.m. to 5 p.m. local time.
Requirements
- Knowledge of and familiarity with all levels of medical services, with 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.
- Experience in the health care field.
- Bachelor’s degree.
- Availability to work from 8 a.m. to 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 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 service lines.
- Educate providers on Health Plan functions and roles in caring for members.
- Provide ongoing educational updates as prescribed by CMS and Health Plan policies.
- Conduct provider education presentations to ensure providers understand and commit to Health Plan requirements.
- 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 TeleDoc access to doctors.
- Optional short- and long-term disability plans.
- Employee Assistance Plan (EAP).
- 401(k) retirement accounts.
- Employee referral bonus program.
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What This Job Offers
Job Type
Full-time
