Provider Relations Specialist – Network & Education

Ultipro; Bloomington (IN); Hybrid; USD 65,000 - 95,000; Full time

Benefits offered by this job

Affordable health insurance

Paid time off and holidays

TeleDoc access to doctors

Disability plans (short and long-term)

Employee Assistance Plan (EAP)

401K retirement plan

Employee Referral Bonus

Job summary

American Health Plans in Bloomington, IN is seeking a Provider Relations professional to contract with providers and vendors, ensure credentialing compliance, and educate network members about plan services. The role includes CMS-driven updates, ongoing education, and maintaining strong provider relationships across service areas.

Travel to network provider locations is required; teleworking is possible if criteria are met.

Qualifications

• Experience in the health care field required.
• Prior network development / network services experience preferred.
• Experience with Medicare Advantage plans is helpful.

Responsibilities

• Contract providers and essential vendors to maintain CMS adequacy and care delivery.
• Ensure providers meet credentialing requirements for their service lines.
• Educate providers on plan functions and roles.
• Carry out CMS-mandated educational updates.
• Present Health Plan information to providers to ensure understanding and commitment.
• Monitor provider relationships to maintain network coverage.

Skills

Medical knowledge

Independent work

Negotiation

Organization

Time management

Communication

Team player

Self-motivated

Education

Bachelor's degree

Job description

American Health Plans in Bloomington, IN is seeking a Provider Relations professional to contract with providers and vendors, ensure credentialing compliance, and educate network members about plan services. The role includes CMS-driven updates, ongoing education, and maintaining strong provider relationships across service areas.

Travel to network provider locations is required; teleworking is possible if criteria are met.