Provider Network Relations Specialist – Education & Growth

American Health Partners; San Antonio (TX); On-site; USD 70,000 - 110,000; Full time

Benefits offered by this job

Affordable Medical/Dental/Vision

Paid time-off and holidays

TeleDoc 24/7/365

Disability plans (short/long-term)

Employee Assistance Plan (EAP)

401K retirement

Employee Referral Bonus Program

Job summary

American Health Plans, a division of American Health Partners Inc., seeks a healthcare professional to manage provider contracting, credentialing, and network development across service areas, with focus on CMS adequacy and plan operations.

The role involves educating providers about Health Plan functions, maintaining relationships, and supporting implementation to ensure broad network coverage and quality care.

Qualifications

• Experience in the health care field.
• Prior experience in network development / network services is preferred.
• Prior experience with acute and post-acute facilities is beneficial.
• Prior experience with Medicare Advantage plans is helpful.

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

Teamwork

Microsoft Office Suite

Self-motivated

Education

Bachelor's degree

Job description

American Health Plans, a division of American Health Partners Inc., seeks a healthcare professional to manage provider contracting, credentialing, and network development across service areas, with focus on CMS adequacy and plan operations.

The role involves educating providers about Health Plan functions, maintaining relationships, and supporting implementation to ensure broad network coverage and quality care.