Provider Relations Representative

TruHealth; Oregon; Hybride; USD 60 000 - 90 000; Plein temps

Avantages offerts par ce poste

Health insurance

Paid time off

TeleDoc access

Disability plans

EAP

401K retirement accounts

Referral bonus

Résumé du poste

American Health Plans, a division of American Health Partners Inc., seeks a skilled network development professional in Oregon to contract providers and key vendors and ensure CMS credentialing standards for Medicare Advantage networks.

The role requires strong negotiation, relationship management, and the ability to educate providers on plan functions. Travel to network locations is required; teleworking is possible for qualifying candidates.

Qualifications

• Experience in the health care field.
• Familiarity with provider contracting and CMS requirements.
• Ability to travel to network provider locations.
• Strong negotiation and communication skills.
• Proficiency with Microsoft Office.

Responsabilités

• Contract providers and essential vendors in current service areas to maintain CMS adequacy and provide necessary services.
• Ensure providers meet credentialing requirements for their service lines.
• Educate providers on Health Plan functions and roles.
• Conduct CMS-prescribed educational updates.
• Present health plan information to providers to ensure buy-in.
• Monitor and support provider relationships to maintain network coverage.
• Collaborate on implementation and process improvements.
• Foster a positive work environment and contribute to department success.
• Complete corporate assignments as needed.

Connaissances

Provider payments

CMS credentialing

Negotiation

Relationship management

Education presentations

Team collaboration

Microsoft Office

Formation

Bachelor's degree

Description du poste

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. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, and Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com .

Benefits and Perks

• 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

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.