Provider Relations & Network Development Specialist

American Health Plans; Westfield (IN); Hybrid; USD 60,000 - 90,000; Full time

Benefits offered by this job

Affordable health insurance

Generous PTO and holidays

TeleDoc 24/7 access to doctors

Disability plans

EAP

401K retirement accounts

Employee Referral Bonus Program

Job summary

American Health Plans, a division of American Health Partners Inc., operates I-SNPs for seniors in long-term care facilities. We seek a collaborative, supportive team member to manage provider contracting, credentialing and education within our network.

Travel to network provider locations is required; teleworking is possible if criteria are met. Standard hours are 8 a.m. to 5 p.m. local time, with a comprehensive benefits package including insurance, PTO, 401K and EAP.

Qualifications

• Experience in health care required.
• Prior network development/services preferred.
• Experience with Medicare Advantage helpful.
• Travel to network provider locations required.
• Teleworking is an option if criteria are met.
• Must be available 8 a.m.–5 p.m. local time.

Responsibilities

• Contract providers and essential vendors to maintain CMS adequacy and provide necessary services.
• Insure providers meet credentialing requirements for their service lines.
• Educate providers on Health Plan functions and roles in caring for membership.
• Ongoing educational updates as prescribed by CMS and Health Plan policies.
• Coordinate provider education presentations to ensure understanding and commitment.
• Monitor and support provider relationships to ensure network coverage.

Skills

Healthcare knowledge

Independent worker

Negotiation skills

Communication with 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. We seek a collaborative, supportive team member to manage provider contracting, credentialing and education within our network.

Travel to network provider locations is required; teleworking is possible if criteria are met. Standard hours are 8 a.m. to 5 p.m. local time, with a comprehensive benefits package including insurance, PTO, 401K and EAP.