Remote Provider Relations Specialist

American Health Communities; San Antonio, Northern (TX, KY); Hybrid; USD 65,000 - 95,000; Full time

Benefits offered by this job

401K retirement accounts

TeleDoc 24/7/365 access to doctors

Paid time-off and holidays

Job summary

American Health Plans, a division of American Health Partners Inc., operates in several states and manages Medicare Advantage plans for seniors in long-term care facilities. The role involves contracting providers, credentialing, and educating providers about plan functions while maintaining CMS compliance and network adequacy.

The position requires travel to network locations, strong negotiation and relationship skills, and the ability to work in a team with a focus on process improvement and

Qualifications

• Must fluently handle provider payment methodologies (per diems, DRGs, APCs).
• Ability to build working relationships across medical staff and providers.
• Strong negotiation, organization, and time-management skills.
• Ability to explain Health Plan program, benefits, and goals to diverse staff.

Responsibilities

• Contract providers and essential 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.
• Maintain provider relationships to ensure network coverage.
• Travel to network provider locations as required.

Skills

Negotiation skills

Time management

Team player

Communication with medical staff

Self-motivated

Education

Bachelor's degree or higher

Job description

American Health Plans, a division of American Health Partners Inc., operates in several states and manages Medicare Advantage plans for seniors in long-term care facilities. The role involves contracting providers, credentialing, and educating providers about plan functions while maintaining CMS compliance and network adequacy.

The position requires travel to network locations, strong negotiation and relationship skills, and the ability to work in a team with a focus on process improvement and