Provider Relations Specialist: Network Growth

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

Benefits offered by this job

Health insurance

Paid time off

TeleDoc access

Disability plans

EAP

401(k) retirement

Referral bonus

Job summary

American Health Plans, a division of American Health Partners Inc., operates I-SNPs for seniors in long-term care facilities. In partnership with nursing home operators, these plans manage medical risk and reduce hospitalizations while improving patient care.

ESSENTIAL FUNCTIONS include contracting providers, credentialing, educating staff on plan operations, and maintaining provider networks. Travel to network locations is required; teleworking is possible if criteria are met.

Qualifications

• Fluent in all current provider payment methodologies including per diems, DRGs, and APCs.
• Knowledge of CMS rules and health plan operations is essential.
• Ability to educate providers on plan functions and policies.

Responsibilities

• Contract providers and vendors in current service areas to maintain CMS adequacy.
• Ensure credentialing requirements are met for service lines.
• Educate providers on Health Plan functions and roles.
• Provide ongoing educational updates as prescribed by CMS and Health Plan policies.
• Conduct education presentations for Health Plan providers to ensure understanding and commitment.
• Monitor and support provider relationships to ensure network coverage in all areas.

Skills

Provider payments

CMS knowledge

Negotiation

Time management

Communication

Team player

Independent work

Education

Bachelor's degree

Job description

American Health Plans, a division of American Health Partners Inc., operates I-SNPs for seniors in long-term care facilities. In partnership with nursing home operators, these plans manage medical risk and reduce hospitalizations while improving patient care.

ESSENTIAL FUNCTIONS include contracting providers, credentialing, educating staff on plan operations, and maintaining provider networks. Travel to network locations is required; teleworking is possible if criteria are met.