Provider Relations & Network Development Specialist

American Health Communities; Goshen (IN); Hybrid; USD 60,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Paid time off

TeleDoc access

Disability plans

EAP

401K

Referral program

Job summary

American Health Plans in Goshen, IN, a division of American Health Partners, is seeking a dedicated professional to manage network services and contract providers for CMS plans. The role emphasizes credentialing, provider education, and building strong relationships to ensure high-quality care for plan members.

You will collaborate across departments, travel to network locations as needed, and may telework if criteria are met.

Qualifications

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

Responsibilities

• Contract providers and essential vendors in current service areas to maintain CMS adequacy and provide services.
• Ensure providers and vendors meet credentialing requirements for their service lines.
• Educate providers on Health Plan functions and roles in caring for members.
• Provide ongoing CMS policy updates as prescribed by Health Plan policies.
• Conduct education presentations to ensure provider understanding and commitment to Health Plan.
• Monitor and support provider relationships to maintain network coverage in all areas.
• Assist with implementation and participate in process improvement initiatives as needed.
• Complete corporate assignments as assigned.

Skills

Medical knowledge

Negotiation

Organization

Time management

Communication

Teamwork

Education

Bachelor's degree or higher

Job description

American Health Plans in Goshen, IN, a division of American Health Partners, is seeking a dedicated professional to manage network services and contract providers for CMS plans. The role emphasizes credentialing, provider education, and building strong relationships to ensure high-quality care for plan members.

You will collaborate across departments, travel to network locations as needed, and may telework if criteria are met.