Provider Network Relations Specialist

American Health Partners; Lexington (KY); Hybrid; USD 60,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Paid time off

TeleDoc 24/7/365 access

401K retirement accounts

Employee referral bonus

Job summary

American Health Plans, a division of American Health Partners Inc., seeks a network development professional to contract providers and key vendors, ensure CMS credentialing, and educate facilities about plan functions.

Responsibilities include maintaining provider relationships across service areas, supporting implementation, and promoting process improvements while accommodating travel to network locations and possible telework.

Qualifications

• Experience in health care field required.
• Knowledge of provider payment methodologies including per diems, DRGs and APCs.
• Ability to educate providers on plan functions and CMS requirements.
• Strong negotiation, organization, and time management skills.

Responsibilities

• Contract providers and vendors in current service areas to maintain CMS adequacy.
• Ensure credentialing requirements are met for service lines.
• Educate providers on plan functions and CMS policies.
• Maintain provider relationships to ensure network coverage.
• Assist with implementation and process improvements as needed.
• Travel to network provider locations as required.
• Support education presentations to ensure provider understanding.
• Complete corporate assignments as assigned.

Skills

Provider payment methodologies

Provider relations

Independent work

Negotiation

Communication with medical staff

Teamwork

Education

Bachelor's degree or higher

Job description

American Health Plans, a division of American Health Partners Inc., seeks a network development professional to contract providers and key vendors, ensure CMS credentialing, and educate facilities about plan functions.

Responsibilities include maintaining provider relationships across service areas, supporting implementation, and promoting process improvements while accommodating travel to network locations and possible telework.