Provider Network Relations Specialist

American Health Communities; Springfield (MO); Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

Health insurance

Paid time off

TeleDoc 24/7 access

Disability plans

Employee Assistance Plan (EAP)

401K retirement

Job summary

American Health Plans in Springfield, MO is seeking a Provider Relations/Network Development professional to contract with providers and essential vendors to maintain CMS adequacy and deliver services to Plan members.

The role requires educating providers on plan functions, credentialing, and ongoing CMS updates, plus travel to network sites. Teleworking is possible when criteria are met; standard hours are 8 a.m. to 5 p.m.

Qualifications

• 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.

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

Negotiation

Organization

Presentation

Time management

Communication

Teamwork

Self-motivated

Education

Bachelor's degree

Job description

American Health Plans in Springfield, MO is seeking a Provider Relations/Network Development professional to contract with providers and essential vendors to maintain CMS adequacy and deliver services to Plan members.

The role requires educating providers on plan functions, credentialing, and ongoing CMS updates, plus travel to network sites. Teleworking is possible when criteria are met; standard hours are 8 a.m. to 5 p.m.