Provider Relations & Network Development Specialist Remote

American Health Plans; San Antonio (TX); On-site; USD 85,000 - 120,000; Full time

Benefits offered by this job

Affordable health options

401K retirement accounts

Paid time off & holidays

TeleDoc access to doctors

Disability plans

Employee Assistance Plan (EAP)

Employee referrals

Job summary

American Health Plans, a division of American Health Partners Inc., seeks a professional to contract providers and manage vendor relationships in current service areas. You will ensure credentialing compliance, educate providers on plan functions, and stay updated with CMS guidelines.

Travel to network sites is required, with teleworking possible if criteria are met. The role supports CMS adequacy and improves patient care across multiple states, including Texas.

Qualifications

• Must be fluent in all current provider payment methodologies including per diems, DRGs, and APCs.
• Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships.
• Must be able to accept instructions and work independently in the completions of goals and assignments.
• 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(s) program, benefits and goals.
• Must be able to work effectively in a team environment.
• Must be self-motivated, dependable, team and goal-oriented.

Responsibilities

• Contracting providers and essential vendors in current service areas to maintain CMS adequacy and providing necessary services in the care of the Plan members.
• Insuring providers and essential vendors in current service areas meet the credentialing requirements for their appropriate service lines.
• Educating providers on the Health Plan(s) functions and roles in caring for its membership.
• Ongoing educational updates as prescribed by CMS and the Health Plan(s) policies.
• To conduct the education presentations of the Health Plan(s) providers to insure their understanding and commitment with the Health Plan(s).
• Monitor, maintain and support provider relationships to insure network coverage in all areas.
• To work with and be involved in implementation as needed.
• Establish a positive work environment that encourages participation in process improvement and commitment to department/company success.
• Complete corporate assignments as assigned.

Skills

Provider payments

Medical services knowledge

Independent work

Negotiation skills

Communication skills

Teamwork

Motivated

Education

Bachelor’s degree

Job description

American Health Plans, a division of American Health Partners Inc., seeks a professional to contract providers and manage vendor relationships in current service areas. You will ensure credentialing compliance, educate providers on plan functions, and stay updated with CMS guidelines.

Travel to network sites is required, with teleworking possible if criteria are met. The role supports CMS adequacy and improves patient care across multiple states, including Texas.