Provider Relations Specialist — Build Networks & Educate Providers

American Health Plans; Fort Worth (TX); Hybrid; USD 70,000 - 95,000; Full time

Benefits offered by this job

Medical insurance

Paid time off

TeleDoc access

Disability plans

EAP

401K plan

Referral bonus

Job summary

American Health Plans, a division of American Health Partners Inc., seeks a provider contracting professional in Fort Worth, TX. You will manage contracting with in-network providers and vendors, ensure CMS credentialing, and educate providers on plan functions to support network adequacy.

Travel to provider locations is required; teleworking may be possible if criteria are met. You will contribute to process improvements and work closely with cross-functional teams to support Medicare Advantage

Qualifications

• Must be fluent in provider payment methods including per diems, DRGs, and APCs.
• Knowledge of medical services levels and ability to build relationships quickly.
• Strong negotiation, organization, presentation and time management skills.
• Able to communicate with all levels of medical staff to explain Health Plan programs, benefits and goals.
• Team player who is self-motivated and goal-oriented.
• Willingness to travel as required.

Responsibilities

• Contract providers and essential vendors in current service areas to maintain CMS adequacy and provide services.
• Ensure credentialing requirements are met for service lines.
• Educate providers on Health Plan functions and roles.
• Provide CMS-mandated educational updates and materials.
• Conduct education presentations to providers to ensure understanding and commitment to Health Plan(s).
• Monitor and support provider relationships to maintain network coverage.
• Collaborate on implementation projects as needed.
• Foster a positive environment and participate in process improvements.
• Complete corporate assignments as assigned.

Skills

Provider payment methods

Credentialing requirements

Negotiation skills

Communication with medical staff

Teamwork

Self-motivation

Education

Bachelor's degree

Job description

American Health Plans, a division of American Health Partners Inc., seeks a provider contracting professional in Fort Worth, TX. You will manage contracting with in-network providers and vendors, ensure CMS credentialing, and educate providers on plan functions to support network adequacy.

Travel to provider locations is required; teleworking may be possible if criteria are met. You will contribute to process improvements and work closely with cross-functional teams to support Medicare Advantage