Provider Relations & Network Development Specialist

American Health Partners; Lubbock (TX); On-site; USD 70,000 - 110,000; Full time

Benefits offered by this job

Medical/Dental/Vision insurance

Paid time-off

TeleDoc access

Disability plans

EAP

401K retirement

Employee Referral Bonus

Job summary

American Health Plans, a division of American Health Partners Inc., seeks a qualified professional to contract providers and ensure CMS adequacy across its Texas service area, including the broader current regions. The role includes educating providers, managing vendor relationships, and coordinating with CMS policies to support plan members.

This position requires healthcare network experience, strong negotiation and communication skills, and the ability to work independently with travel to

Qualifications

• Must be fluent in all provider payment methodologies including per diems, DRGs, and APCs.
• Knowledge of all levels of medical services and ability to rapidly develop working relationships.
• Able to accept instructions and work independently in the completions of goals and assignments.
• Strong negotiation, organization, presentation and time management skills.
• Able to communicate with all levels of medical staff to explain Health Plan programs, benefits and goals.
• Able to work effectively in a team environment.
• Excellent computer skills, including Microsoft Office Suite.
• Must be self-motivated, dependable, team and goal-oriented.

Responsibilities

• Contracting providers and essential vendors in current service areas to maintain CMS adequacy.
• 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.
• Providing ongoing educational updates as prescribed by CMS and Health Plan policies.
• Conducting education presentations to ensure provider understanding and commitment.
• Monitoring and supporting provider relationships to ensure network coverage.
• Working with and being involved in implementation as needed.
• Establishing a positive work environment that encourages process improvement.
• Completing corporate assignments as assigned.

Skills

Provider payment methods

Medical services knowledge

Independent work

Negotiation skills

Communication with staff

Teamwork

Microsoft Office Suite

Self-motivated

Education

Bachelor's degree

Tools

Microsoft Office Suite

Job description

American Health Plans, a division of American Health Partners Inc., seeks a qualified professional to contract providers and ensure CMS adequacy across its Texas service area, including the broader current regions. The role includes educating providers, managing vendor relationships, and coordinating with CMS policies to support plan members.

This position requires healthcare network experience, strong negotiation and communication skills, and the ability to work independently with travel to