Provider Relations Representative

Job Title

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. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, and Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024.

If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!

Benefits and Perks include:

• 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

Essential Functions: To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation

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

Educating 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

Establish a positive work environment that encourages participation in process improvement and commitment to department/company success

Complete corporate assignments as assigned

Required Skills:

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 completions 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

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

Equal Opportunity Employer

Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.

This employer participates in E-Verify.