Provider Relations Specialist – Healthcare Network Growth

American Health Plans; Ashland (KY); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Medical Insurance

Paid Time Off

TeleDoc access

Disability plans

EAP

401K

Referral Bonus

Job summary

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc., operates I-SNPs for seniors in long-term care facilities and contracts with providers and vendors to maintain CMS adequacy across service areas.

The role focuses on credentialing, educating providers, and sustaining network coverage with a collaborative team in a telework-possible environment.

Qualifications

• Experience in the health care field required.
• Prior experience in network development / network services is preferred.
• Knowledge of CMS requirements and Medicare Advantage concepts is helpful.

Responsibilities

• Contract providers and vendors in current service areas to maintain CMS adequacy.
• Ensure providers meet credentialing requirements for their service lines.
• Educate providers on Health Plan functions and roles.
• Stay updated with CMS policies and Health Plan guidelines.
• Educate Health Plan providers through education presentations to ensure understanding and commitment.
• Monitor and support provider relationships to maintain network coverage.
• Collaborate on implementation projects as needed.
• Foster a positive environment encouraging process improvements.

Skills

Provider contracts

Negotiation

Relationship building

Presentation

Time management

Teamwork

Self-motivation

Education

Bachelor's degree

Job description

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc., operates I-SNPs for seniors in long-term care facilities and contracts with providers and vendors to maintain CMS adequacy across service areas.

The role focuses on credentialing, educating providers, and sustaining network coverage with a collaborative team in a telework-possible environment.