Provider Relations & Network Development Specialist

American Health Communities; Columbus (IN); Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical/Dental/Vision insurance

Paid time off & holidays

TeleDoc 24/7/365 access

Disability plans (short & long-term)

Employee Assistance Plan (EAP)

401K retirement

Employee Referral Bonus

Job summary

American Health Plans, a division of American Health Partners Inc., seeks a network development professional to manage provider contracting, credentialing, and relations under CMS frameworks. Travel to network locations is required, and teleworking may be an option.

You will collaborate with nursing home operators to ensure network adequacy while educating providers on plan functions and CMS regulations. This role emphasizes communication, negotiation, and team coordination to deliver

Qualifications

• Experience in health care field required.
• Prior network development / network services preferred.
• Knowledge of CMS requirements and Medicare Advantage programs beneficial.

Responsibilities

• Contract providers and essential vendors to maintain CMS adequacy.
• Ensure credentialing requirements are met for service lines.
• Educate providers on Health Plan functions and roles.
• Provide ongoing CMS-based educational updates.
• Maintain provider relationships to ensure network coverage.
• Support implementation and process improvements.

Skills

Provider contracting

Credentialing

CMS knowledge

Negotiation

Communication

Time management

Team coordination

Education

Bachelor's degree or higher

Job description

American Health Plans, a division of American Health Partners Inc., seeks a network development professional to manage provider contracting, credentialing, and relations under CMS frameworks. Travel to network locations is required, and teleworking may be an option.

You will collaborate with nursing home operators to ensure network adequacy while educating providers on plan functions and CMS regulations. This role emphasizes communication, negotiation, and team coordination to deliver