Provider Relations & Network Development Specialist

American Health Communities; Westfield (IN); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical Insurance

Paid time off

TeleDoc 24/7/365

Disability plans

EAP

401K retirement

Job summary

American Health Plans, a division of American Health Partners Inc., seeks professionals in Indiana to coordinate provider contracting and network services for CMS plans. The role focuses on credentialing, education of providers, and maintaining strong network relationships.

The position requires travel to network locations, a strong healthcare background, and the ability to work independently and within a team to support plan members and providers.

Qualifications

• Experience in health care field required.
• Prior experience in network development / network services is preferred.
• Prior experience with Medicare Advantage plans is helpful.
• Must be available to travel to network provider locations.

Responsibilities

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

Skills

Negotiation

Organization

Presentation

Time management

Communication

Teamwork

Self-motivation

Education

Bachelor's degree or higher

Job description

American Health Plans, a division of American Health Partners Inc., seeks professionals in Indiana to coordinate provider contracting and network services for CMS plans. The role focuses on credentialing, education of providers, and maintaining strong network relationships.

The position requires travel to network locations, a strong healthcare background, and the ability to work independently and within a team to support plan members and providers.