Provider Relations Representative
American Health Partners · Denton County, TX · 2 wk ago
HealthcareFull-time
Essential Functions
- 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
- Education 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
- To work with and be involved in implementation as needed
- To establish a positive work environment that encourages participation in process improvement and commitment to department/company success
- To complete corporate assignments as assigned
Required Skills
- Knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships
- Accept instructions and work independently in the completions of goals and assignments
- Strong negotiation, organization, presentation and time management skills
- Effective communication with all levels of medical staff to explain Health Plan(s) program, benefits and goals
- Excellent computer skills, including Microsoft Office Suite
- Self-motivated, dependable, team and goal-oriented
Required Work Experience
- 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
Licensing/Certification/Education Requirements
- Bachelor’s degree
Other Requirements
- Must be available to work 8 a.m. until 5 p.m. local time
- Position requires travel to network provider locations
- Teleworking is an option if criteria are met