Provider Relations Pro | Network Growth & Education

American Health Communities; Fort Worth (TX); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical/Dental/Vision insurance

Paid time-off and holidays

TeleDoc 24/7/365 access

Disability plans

EAP

401K retirement

Referral bonus

Job summary

American Health Plans Fort Worth, TX is seeking a Provider Network Development Specialist to contract providers and vendors within current service areas, ensuring CMS adequacy and access to necessary services for Plan members.

You will educate providers on plan functions, maintain provider relationships, and support implementation across CMS guidelines, with travel to provider sites and potential telework options.

Qualifications

• Must be fluent in provider payment methodologies including per diems, DRGs, and APCs.
• Ability to rapidly develop working relationships with medical staff and vendors.
• Strong negotiation, organization, presentation and time-management skills.

Responsibilities

• Contract providers and essential vendors in current service areas to maintain CMS adequacy and services for Plan members.
• Educate providers on Health Plan functions and roles; ensure credentialing for service lines.
• Monitor provider relationships to insure network coverage and support implementation initiatives.
• Establish a positive work environment and participate in process improvement.
• Travel to network provider locations as required; teleworking may be possible under criteria.

Skills

Provider payment methodologies

Relationship building

Independent work

Negotiation

Clear communication

Team collaboration

Self-motivation

Education

Bachelor's degree or higher

Job description

American Health Plans Fort Worth, TX is seeking a Provider Network Development Specialist to contract providers and vendors within current service areas, ensuring CMS adequacy and access to necessary services for Plan members.

You will educate providers on plan functions, maintain provider relationships, and support implementation across CMS guidelines, with travel to provider sites and potential telework options.