Provider Relations Representative

About the role

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!

Benefits

• Affordable Medical/Dental/Vision insurance options
• Generous paid time-off program and paid holidays for full‑time staff
• TeleDoc 24/7/365 access to doctors
• Optional short‑ and long‑term disability plans
• Employee Assistance Plan (EAP)
• 401K retirement accounts
• Employee Referral Bonus Program

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
• Ensuring 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
• Providing ongoing educational updates as prescribed by CMS and the Health Plan(s) policies
• Conducting education presentations of the Health Plan(s) providers to ensure their understanding and commitment with the Health Plan(s)
• Monitoring, maintaining and supporting provider relationships to ensure network coverage in all areas
• Working with and being involved in implementation as needed
• Establishing a positive work environment that encourages participation in process improvement and commitment to department/company success
• Completing corporate assignments as assigned

Skills

• Knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships
• Ability to accept instructions and work independently in the completion of goals and assignments
• Strong negotiation, organization, presentation and time management skills
• Ability to effectively communicate with all levels of medical staff to explain Health Plan(s) program, benefits and goals
• Ability to work effectively in a team environment
• Excellent computer skills, including Microsoft Office Suite
• Self‑motivated, dependable, team and goal‑oriented

Requirements

• 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

Qualifications

• Bachelor’s degree

Schedule

• 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