Provider Network Relations Specialist

American Health Partners; Omaha (NE); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Affordable Medical/Dental/Vision

Paid time-off and holidays

TeleDoc 24/7/365 access

Disability plans

Employee Assistance Plan

401K retirement accounts

Employee Referral Bonus

Job summary

American Health Plans, a division of American Health Partners Inc., operates I-SNPs for seniors in long-term care facilities in partnership with nursing homes. The role involves contracting providers and vendors, credentialing, provider education, CMS updates, and maintaining network coverage across service areas.

Travel to network provider locations is required; teleworking is an option if criteria are met.

Qualifications

• Fluent in provider payment methodologies (per diems, DRGs, APCs).
• Knowledge of medical services levels and ability to build relationships.
• Capable of working independently to meet goals.
• Strong negotiation, organization, presentation, and time management.
• Effective communication with all levels of medical staff about Health Plan programs.
• Able to work well in a team.
• Proficient with Microsoft Office Suite.
• Self-motivated, dependable, team and goal-oriented.

Responsibilities

• Contract providers and vendors to maintain CMS adequacy.
• Ensure credentialing requirements for service lines.
• Educate providers on Health Plan functions and roles.
• Provide CMS-prescribed educational updates.
• Conduct education presentations for Health Plan providers.
• Manage provider relationships to ensure network coverage.
• Participate in implementation as needed.
• Foster positive environment and process improvement.
• Complete corporate assignments as assigned.

Skills

Provider payments

CMS knowledge

Vendor relationships

Negotiation

Time management

Communication skills

Microsoft Office Suite

Independent work

Education

Bachelor's degree

Tools

Microsoft Office Suite

Job description

American Health Plans, a division of American Health Partners Inc., operates I-SNPs for seniors in long-term care facilities in partnership with nursing homes. The role involves contracting providers and vendors, credentialing, provider education, CMS updates, and maintaining network coverage across service areas.

Travel to network provider locations is required; teleworking is an option if criteria are met.