Provider Relations Representative

Job TitleAmerican 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 optionsGenerous paid time-off program and paid holidays for full time staffTeleDoc 24/7/365 access to doctorsOptional short- and long-term disability plansEmployee Assistance Plan (EAP)401K retirement accountsEmployee Referral Bonus ProgramESSENTIAL FUNCTIONS: To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodationContracting providers and essential vendors in current service areas to maintain CMS adequacy and providing necessary services in the care of the Plan membersInsuring providers and essential vendors in current service areas meet the credentialing requirements for their appropriate service linesEducating providers on the Health Plan(s) functions and roles in caring for its membershipOngoing educational updates as prescribed by CMS and the Health Plan(s) policiesTo 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 areasTo work with and be involved in implementation as neededEstablish a positive work environment that encourages participation in process improvement and commitment to department/company successComplete corporate assignments as assignedRequired Skills:Must be fluent in all current provider payment methodologies including per diems, DRGs, and APCsMust have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationshipsMust be able to accept instructions and work independently in the completions of goals and assignmentsMust have strong negotiation, organization, presentation and time management skillsMust be able to effectively communicate with all levels of medical staff to explain Health Plan(s) program, benefits and goalsMust be able to work effectively in a team environmentExcellent computer skills, including Microsoft Office SuiteMust be self-motivated, dependable, team and goal-orientedRequired Work Experience:Experience in the health care field requiredPrior experience in network development / network services is preferredPrior experience with acute and post-acute facilities is beneficialPrior experience with Medicare Advantage plans is helpfulLicensing/Certification/Education Requirements:Bachelor's degreeOther Requirements:Must be available to work 8 a.m. until 5 p.m. local timePosition requires travel to network provider locations.Teleworking is an option if criteria are metEQUAL OPPORTUNITY EMPLOYEROur 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. American Health Partners