Provider Relations & Network Development Specialist

American Health Communities; Dallas (TX); Hybrid; USD 70,000 - 110,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Paid time off

TeleDoc access

Disability plans

EAP

401K retirement

Referral bonus

Job summary

American Health Plans in North Dallas, TX, is seeking a Network Development professional to contract providers and maintain CMS adequacy for Medicare Advantage services. You will educate providers on plan functions, monitor relationships, and coordinate credentialing requirements across the network.

Travel to network locations is required, and teleworking is possible if criteria are met. The company offers comprehensive benefits and supports equal opportunity employment.

Qualifications

• Knowledge of medical services and ability to develop relationships
• Able to follow instructions and work independently
• Strong negotiation and time management skills
• Effective communication with medical staff about plans, benefits and goals
• Able to work well in a team
• Self-motivated, dependable and goal-oriented

Responsibilities

• Contract providers and vendors to maintain CMS adequacy
• Ensure credentialing meets requirements for service lines
• Educate providers on Health Plan functions and roles
• Provide CMS-prescribed educational updates
• Educate Health Plan providers to ensure understanding and commitment
• Monitor and support provider relationships for network coverage
• Support implementation and process improvement
• Complete corporate assignments

Skills

Negotiation

Organization

Presentation

Time management

Communication

Teamwork

Independent work

Education

Bachelor's degree

Job description

American Health Plans in North Dallas, TX, is seeking a Network Development professional to contract providers and maintain CMS adequacy for Medicare Advantage services. You will educate providers on plan functions, monitor relationships, and coordinate credentialing requirements across the network.

Travel to network locations is required, and teleworking is possible if criteria are met. The company offers comprehensive benefits and supports equal opportunity employment.