Provider Relations Specialist - Medicare Advantage Networks

American Health Communities; Lubbock (TX); On-site; USD 90,000 - 130,000; 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 American Health Partners Inc., seeks a network development professional to contract providers and essential vendors across service areas, ensuring CMS adequacy and quality care for Plan members.

The role educates providers on Health Plan functions, maintains credentials, and fosters strong provider relationships while coordinating updates per CMS policies. Travel to network locations is required.

Qualifications

• 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.

Responsibilities

• 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

Skills

Provider payment methods

Medical services knowledge

Independent work

Negotiation & time mgmt

Communication with medical staff

Teamwork

Self-motivation

Education

Bachelor's degree or higher

Job description

American Health Plans, a division of American Health Partners Inc., seeks a network development professional to contract providers and essential vendors across service areas, ensuring CMS adequacy and quality care for Plan members.

The role educates providers on Health Plan functions, maintains credentials, and fosters strong provider relationships while coordinating updates per CMS policies. Travel to network locations is required.