Provider Relations Representative

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.

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 for the Health Plan(s) providers to ensure their understanding and commitment
• 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

Requirements

• Must be fluent in all current provider payment methodologies including per diems, DRGs, and APCs
• Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships
• Must be able to accept instructions and work independently in the completion of goals and assignments
• Must have strong negotiation, organization, presentation, and time management skills
• Must be able to effectively communicate with all levels of medical staff to explain Health Plan(s) program, benefits, and goals
• Must be able to work effectively in a team environment
• Excellent computer skills, including Microsoft Office Suite
• Must be self-motivated, dependable, team and goal-oriented

Qualifications

• Bachelor’s degree
• 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

Schedule

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.