Provider Relations & Network Development Specialist

American Health Plans; Hattiesburg (MS); Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

Affordable health insurance

Generous PTO

TeleDoc access

Disability plans

Employee Assistance Plan

401K retirement

Referral bonus

Job summary

American Health Plans, a division of American Health Partners Inc., operates I-SNPs for seniors in long-term care facilities. The organization contracts providers and vendors, ensures credentialing, and educates providers about plan functions to maintain CMS adequacy and robust network coverage in multiple states.

Teleworking is an option for qualified roles; travel to network provider locations is required. Bachelor's degree preferred; benefits include comprehensive health options and 401K.

Qualifications

• Must understand per diems, DRGs and APCs.
• Knowledge of levels of medical services and ability to build relationships.
• Able to take instructions and work independently toward goals.

Responsibilities

• Contract providers and vendors in current service areas to maintain CMS adequacy.
• Ensure credentialing requirements are met for service lines.
• Educate providers on health plan functions and roles.
• Provide ongoing CMS-compliant educational updates.
• Conduct education presentations to ensure provider understanding and commitment.
• Maintain provider relationships to ensure network coverage across areas.
• Collaborate on implementation and process improvements.
• Support corporate assignments as needed.

Skills

Provider payment methods

Medical services knowledge

Independent work

Negotiation skills

Communication with medical staff

Team player

Self-motivated

Education

Bachelor's degree

Job description

American Health Plans, a division of American Health Partners Inc., operates I-SNPs for seniors in long-term care facilities. The organization contracts providers and vendors, ensures credentialing, and educates providers about plan functions to maintain CMS adequacy and robust network coverage in multiple states.

Teleworking is an option for qualified roles; travel to network provider locations is required. Bachelor's degree preferred; benefits include comprehensive health options and 401K.