Provider Relations Representative

A quick overview of the organization:
American Health Plans, a division of American Health Partners Inc., is based in Tennessee. The company 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.

Locations
:
Durant, OK 74701, USA;
Sherman, TX 75090, USA

To be part of a collaborative, supportive, and caring team, we look forward to receiving your application!

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

• Contract with providers and essential vendors in current service areas to maintain CMS adequacy and provide necessary services in the care of the Plan members.
• Ensure providers and essential vendors meet the credentialing requirements for their appropriate service lines.
• Educate providers on the Health Plan(s) functions and roles in caring for its membership.
• Provide ongoing educational updates as prescribed by CMS and the Health Plan(s) policies.
• Conduct education presentations of the Health Plan(s) providers to assure their understanding and commitment with the Health Plan(s).
• Monitor, maintain, and support provider relationships to assure network coverage in all areas.
• 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.

• Knowledge and familiarity with all levels of medical services and the ability to rapidly develop working relationships.
• Ability to accept instructions and work independently to complete 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.
• Ability to work effectively in a team environment.
• Self‑motivated, dependable, team‑ and goal‑oriented.

• Experience in the health‑care field required.
• Prior experience in network development/network services preferred.
• Prior experience with acute and post‑acute facilities beneficial.
• Prior experience with Medicare Advantage plans helpful.

• 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.

Bachelor's degree or higher.

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.