Provider Relations Representative

American Health Communities; Goshen (IN); Hybrid; USD 60,000 - 90,000; Full time

Benefits offered by this job

Health insurance

Paid time off

TeleDoc access

Disability plans

EAP

401K

Referral program

Job summary

American Health Plans in Goshen, IN, a division of American Health Partners, is seeking a dedicated professional to manage network services and contract providers for CMS plans. The role emphasizes credentialing, provider education, and building strong relationships to ensure high-quality care for plan members.

You will collaborate across departments, travel to network locations as needed, and may telework if criteria are met.

Qualifications

• Must have knowledge of medical services and the ability to rapidly develop working relationships.
• Must be able to work independently to complete goals and assignments.
• Strong negotiation, organization, presentation and time management skills.
• Must communicate effectively with all levels of medical staff to explain Health Plan program, benefits and goals.
• Must be able to work well in a team environment.
• Self-motivated, dependable, and goal-oriented.

Responsibilities

• Contract providers and essential vendors in current service areas to maintain CMS adequacy and provide services.
• Ensure providers and vendors meet credentialing requirements for their service lines.
• Educate providers on Health Plan functions and roles in caring for members.
• Provide ongoing CMS policy updates as prescribed by Health Plan policies.
• Conduct education presentations to ensure provider understanding and commitment to Health Plan.
• Monitor and support provider relationships to maintain network coverage in all areas.
• Assist with implementation and participate in process improvement initiatives as needed.
• Complete corporate assignments as assigned.

Skills

Medical knowledge

Negotiation

Organization

Time management

Communication

Teamwork

Education

Bachelor's degree or higher

Job description

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.

If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!

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: To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation

• 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
• 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:

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.

Qualifications

Education

Required

Bachelors or better.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.