Job Details
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, Mississippi, Louisiana, Iowa, Idaho, and Indiana with planned expansion into other states in 2025. For more information, visit AmHealthPlans.com.
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
Job Summary: The Provider Relations Representative will analyze assigned existing market needs, performs some standard contracting functions, educate providers and provider service entities, maintain business relationships for the Health Plan(s), report on provider and market changes, act as a support for other service areas for the Health Plan(s).
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 in North Central Louisiana.
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.