Provider Relations & Network Development Specialist

American Health Partners; Fort Worth (TX); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Affordable health insurance

Paid time off

TeleDoc 24/7 access

Disability plans

EAP

401K

Referral bonus

Job summary

American Health Plans, a division of American Health Partners Inc., is seeking a network development professional to support CMS adequacy, credentialing, and provider relations across our service areas.

You will contract providers, educate on plan functions, and help implement program updates while traveling to network sites as needed. A bachelor’s degree and health-care experience are required or preferred.

Qualifications

• Experience in the health care field required.
• Prior experience in network development / network services is preferred.
• Prior experience with Medicare Advantage plans is helpful.
• Bachelor's degree is required

Responsibilities

• Contract 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 payments

Relationship building

Communication skills

Time management

Presentation skills

Team player

Microsoft Office

Self-motivated

Education

Bachelor's degree

Tools

Credentialing databases

Job description

American Health Plans, a division of American Health Partners Inc., is seeking a network development professional to support CMS adequacy, credentialing, and provider relations across our service areas.

You will contract providers, educate on plan functions, and help implement program updates while traveling to network sites as needed. A bachelor’s degree and health-care experience are required or preferred.