Provider Relations Specialist – Healthcare Network Growth

American Health Communities; Hattiesburg (MS); Hybrid; USD 70,000 - 90,000; Full time

Benefits offered by this job

Affordable medical/vision insurance

Generous paid time off

TeleDoc 24/7/365 access to doctors

Disability plans

Employee Assistance Plan (EAP)

401K retirement accounts

Employee Referral Bonus Program

Job summary

American Health Plans, a division of American Health Partners Inc., operates Medicare Advantage I-SNPs for seniors in long-term care facilities. The role focuses on contracting providers, credentialing, and educating networks to meet CMS requirements and ensure strong membership care.

The position involves travel to network locations, teleworking options if criteria are met, and collaboration with multiple teams to maintain network adequacy and quality services.

Qualifications

• Experience with provider contracts and credentialing for CMS programs.
• Understanding of CMS rules and Health Plan policies.
• Ability to educate providers about plan functions and benefits.

Responsibilities

• 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; provide CMS guidance updates.
• Conduct ongoing educational updates per CMS and plan policies.
• Deliver education presentations to ensure provider understanding and commitment.
• Maintain provider relationships to ensure network coverage in all areas.
• Collaborate on implementation and process improvements.
• Complete corporate assignments as assigned.

Skills

Provider payment methods

Medical services knowledge

Independent work

Negotiation

Communication with medical staff

Teamwork

Self-motivation

Education

Bachelor's degree

Job description

American Health Plans, a division of American Health Partners Inc., operates Medicare Advantage I-SNPs for seniors in long-term care facilities. The role focuses on contracting providers, credentialing, and educating networks to meet CMS requirements and ensure strong membership care.

The position involves travel to network locations, teleworking options if criteria are met, and collaboration with multiple teams to maintain network adequacy and quality services.