Provider Relations Representative, Sr. jobs in Georgia

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, Iowa, Louisiana, Idaho and Indiana with planned expansion into other states in 2025. For more information, visit AmHealthPlans.com.

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, educates providers and provider service entities, maintain business relationships for the Health Plan(s), reports on provider and market changes, acts as a support for other service areas for the Health Plan(s).

ESSENTIAL JOB DUTIES: 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

• 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

• 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 and partner nursing homes in Idaho.

• 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.