Provider Network Relations Specialist

American Health Plans; Omaha (NE); Hybrid; USD 65,000 - 95,000; Full time

Benefits offered by this job

Affordable Medical/Dental/Vision plans

Generous 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 partners with nursing home operators to manage medical risk and reduce ER visits. Omaha, NE office location supports contracting, credentialing, and education of providers in CMS-aligned networks.

The role emphasizes independent work, strong negotiation, and cross-functional collaboration to strengthen network coverage and ensure service

Qualifications

• Must be fluent in all current provider payment methodologies including per diems, DRGs, and APCs.
• Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships.
• Must be able to accept instructions and work independently in the completions of goals and assignments.
• Must have strong negotiation, organization, presentation and time management skills.
• Must be able to effectively communicate with all levels of medical staff to explain Health Plan(s) program, benefits and goals.
• Must be able to work effectively in a team environment.
• Must be self-motivated, dependable, team and goal-oriented.

Responsibilities

• Contracting providers and essential vendors in current service areas to maintain CMS adequacy and providing necessary services in the care of the Plan members
• Insuring providers and essential vendors in current service areas meet the credentialing requirements for their appropriate service lines
• Educating providers on the Health Plan(s) functions and roles in caring for its membership
• Ongoing educational updates as prescribed by CMS and the Health Plan(s) policies
• To conduct the education presentations of the Health Plan(s) providers to insure their understanding and commitment with the Health Plan(s)
• Monitor, maintain and support provider relationships to insure network coverage in all areas
• To work with and be involved in implementation as needed
• Establish a positive work environment that encourages participation in process improvement and commitment to department/company success
• Complete corporate assignments as assigned

Skills

Provider payment methodologies

Medical services knowledge

Independent work

Negotiation

Communication with medical staff

Team collaboration

Self-motivated

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 partners with nursing home operators to manage medical risk and reduce ER visits. Omaha, NE office location supports contracting, credentialing, and education of providers in CMS-aligned networks.

The role emphasizes independent work, strong negotiation, and cross-functional collaboration to strengthen network coverage and ensure service