Provider Relations Representative

American Health Partners; Dallas (TX); Ibrido; USD 70.000 - 100.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical/Dental/Vision insurance

PTO and holidays

TeleDoc 24/7/365

Disability plans

EAP

401K

Referral bonus

Descrizione del lavoro

American Health Plans, a division of American Health Partners, seeks a network/credentialing liaison in Dallas to manage provider relationships and education. The role supports CMS adequacy and network coverage.

The candidate should bring healthcare experience, strong negotiation and communication skills, and the ability to work independently within a team. Teleworking may be available and travel is required.

Competenze

• Knowledge of medical services and ability to build relationships quickly.
• Able to work independently to complete goals.
• Strong negotiation, organization, presentation, and time-management skills.
• Effective communication with medical staff to explain plan benefits and goals.
• Ability to work well in a team environment.
• Excellent computer skills, including MS Office.
• Self-motivated, dependable, and goal-oriented.

Mansioni

• Contract providers and essential vendors to maintain CMS adequacy and services for Plan members.
• Ensure providers meet credentialing requirements for their service lines.
• Educate providers on Health Plan functions and roles in caring for members.
• Provide ongoing CMS-prescribed educational updates.
• Deliver provider education presentations to ensure understanding and commitment.
• Monitor and support provider relationships to guarantee network coverage.
• Assist in implementation as needed and contribute to process improvements.
• Foster a positive work environment and complete corporate assignments.

Conoscenze

Medical knowledge

Independent work

Negotiation

Communication

Team player

MS Office

Self-motivated

Formazione

Bachelor’s degree

Strumenti

Microsoft Office Suite

Descrizione del lavoro

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations.

Benefits And Perks Include

• Affordable Medical/Dental/Vision insurance options
• Generous paid time-off program and paid holidays for full time staff
• TeleDoc 24/7/365 access to doctors
• Optional short- and long-term disability plans
• Employee Assistance Plan (EAP)
• 401K retirement accounts
• Employee Referral Bonus Program

ESSENTIAL FUNCTIONS

• 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

Required Skills

• 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
• Excellent computer skills, including Microsoft Office Suite
• Must be self-motivated, dependable, team and goal-oriented

Required Work Experience

• Experience in the health care field required
• Prior experience in network development / network services is preferred
• Prior experience with acute and post-acute facilities is beneficial
• Prior experience with Medicare Advantage plans is helpful

Licensing/Certification/Education Requirements

• Bachelor’s degree

Other Requirements

• Must be available to work 8 a.m. until 5 p.m. local time
• Position requires travel to network provider locations.
• Teleworking is an option if criteria are met

EQUAL OPPORTUNITY EMPLOYER

Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made. This employer participates in E-Verify.