Provider Relations & Network Specialist

American Health Plans; Lubbock (TX); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Paid time off

TeleDoc access

Disability plans (short/long-term)

EAP

401K

Employee referral program

Job summary

American Health Plans, a division of American Health Partners Inc., operates I-SNPs for seniors in long-term care facilities and partners with nursing homes to reduce ER visits and hospitalizations. The role focuses on contracting, credentialing, and educating providers to ensure CMS adequacy and strong network coverage across multiple states.

Position requires travel to provider locations; teleworking may be an option if criteria are met.

Qualifications

• Must understand provider payment methods (per diems, DRGs, APCs).
• Experience in health care field is required.
• Medicare Advantage plans knowledge is helpful.

Responsibilities

• Contract providers and vendors to maintain CMS adequacy and services for Plan members.
• Ensure credentialing compliance for providers in service areas.
• Educate providers on Health Plan functions and roles.
• Provide ongoing CMS-guided updates and education to providers.
• Maintain provider relationships to insure network coverage in all areas.
• Assist in implementation and participate in process improvements.

Skills

Provider payment methods

Medical services knowledge

Independent work

Time management

Communication with medical staff

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 and partners with nursing homes to reduce ER visits and hospitalizations. The role focuses on contracting, credentialing, and educating providers to ensure CMS adequacy and strong network coverage across multiple states.

Position requires travel to provider locations; teleworking may be an option if criteria are met.