Provider Relations & Network Development Specialist

American Health Plans; Kansas City (KS); Hybride; USD 70 000 - 90 000; Plein temps

Avantages offerts par ce poste

Medical insurance

PTO and holidays

TeleDoc access

Disability plans

EAP

Résumé du poste

American Health Plans in Kansas City, MO area is seeking a contracting and provider relations specialist. This role focuses on contracting providers and essential vendors, credentialing compliance, and educating providers on plan functions.

You will support CMS policies, maintain network coverage, and participate in implementation efforts while fostering a collaborative, results-driven team environment.

Qualifications

• Must have knowledge and familiarity with all levels of medical services.
• Must be able to accept instructions and work independently to achieve goals.
• Must have strong negotiation, organization, presentation and time management skills.
• Must be able to effectively communicate with all levels of medical staff to explain Health Plan program, benefits and goals.
• Must be able to work effectively in a team environment.
• Must be self-motivated, dependable, team and goal-oriented.

Responsabilités

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

Connaissances

Provider contracting

Vendor management

CMS compliance

Negotiation

Education & training

Communication

Formation

Bachelor's degree or higher

Description du poste

American Health Plans in Kansas City, MO area is seeking a contracting and provider relations specialist. This role focuses on contracting providers and essential vendors, credentialing compliance, and educating providers on plan functions.

You will support CMS policies, maintain network coverage, and participate in implementation efforts while fostering a collaborative, results-driven team environment.