Provider Network Relations Specialist

American Health Plans; Lubbock (TX); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Affordable Medical Insurance

Paid time off and holidays

TeleDoc 24/7/365 access to doctors

Disability plans (short/long-term)

Employee Assistance Plan (EAP)

401K retirement accounts

Employee Referral Bonus Program

Job summary

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc., operates I-SNPs for seniors in long-term care facilities and manages CMS networks across multiple states. This role supports contracting, credentialing, and education of providers to maintain CMS adequacy and high-quality care.

The position requires travel to network provider locations; teleworking is an option if criteria are met. Equal opportunity employer with comprehensive benefits and 401K options.

Qualifications

• Experience in the health care field required.
• Prior experience in network development / network services is preferred.
• Prior experience with Medicare Advantage plans is helpful.

Responsibilities

• Contracting providers and essential vendors in current service areas to maintain CMS adequacy.
• Insuring providers and essential vendors meet credentialing requirements for their service lines.
• Educating providers on Health Plan(s) functions and roles.
• Ongoing educational updates as prescribed by CMS and Health Plan policies.
• Conduct education presentations to ensure provider understanding and commitment to Health Plan(s).
• Monitor and support provider relationships to ensure network coverage in all areas.

Skills

Provider payment methods

Medical services knowledge

Independent work

Negotiation

Organization

Presentation

Time management

Communication with medical staff

Teamwork

Education

Bachelor's degree

Job description

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc., operates I-SNPs for seniors in long-term care facilities and manages CMS networks across multiple states. This role supports contracting, credentialing, and education of providers to maintain CMS adequacy and high-quality care.

The position requires travel to network provider locations; teleworking is an option if criteria are met. Equal opportunity employer with comprehensive benefits and 401K options.