Provider Relations Representative

American Health Partners; Omaha (NE); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Affordable Medical/Dental/Vision

Paid time-off and holidays

TeleDoc 24/7/365 access

Disability plans

Employee Assistance Plan

401K retirement accounts

Employee Referral Bonus

Job summary

American Health Plans, a division of American Health Partners Inc., operates I-SNPs for seniors in long-term care facilities in partnership with nursing homes. The role involves contracting providers and vendors, credentialing, provider education, CMS updates, and maintaining network coverage across service areas.

Travel to network provider locations is required; teleworking is an option if criteria are met.

Qualifications

• Fluent in provider payment methodologies (per diems, DRGs, APCs).
• Knowledge of medical services levels and ability to build relationships.
• Capable of working independently to meet goals.
• Strong negotiation, organization, presentation, and time management.
• Effective communication with all levels of medical staff about Health Plan programs.
• Able to work well in a team.
• Proficient with Microsoft Office Suite.
• Self-motivated, dependable, team and goal-oriented.

Responsibilities

• Contract providers and vendors to maintain CMS adequacy.
• Ensure credentialing requirements for service lines.
• Educate providers on Health Plan functions and roles.
• Provide CMS-prescribed educational updates.
• Conduct education presentations for Health Plan providers.
• Manage provider relationships to ensure network coverage.
• Participate in implementation as needed.
• Foster positive environment and process improvement.
• Complete corporate assignments as assigned.

Skills

Provider payments

CMS knowledge

Vendor relationships

Negotiation

Time management

Communication skills

Microsoft Office Suite

Independent work

Education

Bachelor's degree

Tools

Microsoft Office Suite

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.

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 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
• 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.