Provider Relations & Network Development Specialist

American Health Plans; Dallas (TX); Hybrid; USD 60,000 - 95,000; Full time

Benefits offered by this job

Affordable Medical/Dental/Vision

Generous paid time-off

TeleDoc 24/7/365

Disability plans

EAP

401K retirement accounts

Referral program

Job summary

American Health Plans, a division of American Health Partners Inc., seeks a provider relations professional in Dallas, TX, to contract providers and manage essential vendors across CMS regions. You will educate providers on plan functions, monitor network coverage, and drive credentialing and process improvements.

The role requires strong negotiation, communication with medical staff, and independent, team-oriented work habits.

Qualifications

• Must have knowledge of medical services and the ability to develop working relationships quickly.
• Ability to work independently to complete goals and assignments.
• Strong negotiation, organization, presentation and time management skills.
• Ability to communicate with all levels of medical staff to explain Health Plan programs, benefits and goals.
• Ability to work effectively in a team environment.
• Self-motivated, dependable, team and goal-oriented.

Responsibilities

• Contracting providers and essential vendors in current service areas to maintain CMS adequacy and provide necessary services.
• Insuring providers and essential vendors meet credentialing requirements for their service lines.
• Educating providers on Health Plan functions and roles in caring for its membership.
• Ongoing educational updates as prescribed by CMS and Health Plan policies.
• Conduct education presentations of Health Plan providers to ensure understanding and commitment.
• Monitor, maintain and support provider relationships to ensure network coverage in all areas.
• Work with and be involved in implementation as needed.
• Establish a positive work environment that encourages participation in process improvement and department/company success.
• Complete corporate assignments as assigned.

Skills

Provider contracting

Vendor relations

CMS credentialing

Education presentations

Negotiation

Time management

Communication with medical staff

Team collaboration

Independent working

Education

Bachelor's degree or higher

Job description

American Health Plans, a division of American Health Partners Inc., seeks a provider relations professional in Dallas, TX, to contract providers and manage essential vendors across CMS regions. You will educate providers on plan functions, monitor network coverage, and drive credentialing and process improvements.

The role requires strong negotiation, communication with medical staff, and independent, team-oriented work habits.