Provider Relations Representative

3 weeks ago

Milledgeville, United States American Health Plans Full time

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.

  • Provider Relations Representative

    3 weeks ago

    Milledgeville, United States American Health Plans Full time

    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...

  • Provider Relations Representative

    4 weeks ago

    Milledgeville, United States American Health Plans Full time

    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...

  • Behavioral Health Provider

    1 month ago

    Milledgeville, United States GeorgiaGov Full time

    We are currently seeking a Behavioral Health Provider (LPC) who can provide services for our IFID (Intensive Family Intervention Detail program. As well asto join our team in making a difference in the lives of our patients every day.We are located in the heart of Middle Georgia State where we enjoy abundant recreational opportunities, and a family...

  • Behavioral Health Provider

    3 weeks ago

    Milledgeville, United States GeorgiaGov Full time

    We are currently seeking a Behavioral Health Provider (LPC) who can provide services for our IFID (Intensive Family Intervention Detail program. As well asto join our team in making a difference in the lives of our patients every day.We are located in the heart of Middle Georgia State where we enjoy abundant recreational opportunities, and a family...

  • Inside Sales Representative

    3 weeks ago

    Milledgeville, United States Smyrna Truck and Cargo Full time

    **Inside Sales Representative** Fouts Bros is a family-owned business since 1952 with facilities in Georgia and Texas. Fouts Bros is proud to have become one of the largest and most diverse commercial truck manufacturers in the US. Fouts Bros is committed to developing new commercial vehicles that provide industry-best value, quality, and...

  • Area Representative

    4 weeks ago

    Milledgeville, United States Fellowship of Christian Athletes Full time

    Job Description The Representative works with the Director and Advisory Team to fulfill the FCA Vision, pursue the FCA Mission and live the FCA Values by implementing the ministry plan for the assigned area. In the FCA Sports Environments, the Representative ensures there is a consistent approach to discipleshipmaking disciples who make disciples. The...

  • Area Representative

    2 weeks ago

    Milledgeville, United States Fellowship of Christian Athletes Full time

    Job Description The Representative works with the Director and Advisory Team to fulfill the FCA Vision, pursue the FCA Mission and live the FCA Values by implementing the ministry plan for the assigned area. In the FCA Sports Environments, the Representative ensures there is a consistent approach to discipleshipmaking disciples who make disciples. The...

  • Customer Relations Representative

    1 month ago

    Milledgeville, United States Ed Freeman - State Farm Agent Full time

    Job DescriptionJob DescriptionPosition Overview:Are you outgoing and customer-focused? Do you enjoy working with the public? If you answered yes to these questions, working for a State Farm independent contractor agent may be the career for you! State Farm agents market only State Farm insurance and financial service products.Responsibilities:Establish...

  • Customer Relations Specialist

    1 month ago

    Milledgeville, United States Bug House Pest Control Full time

    Overview: Are you looking to join a team of dedicated and friendly professionals? As part of the Bug House Pest Control team, youll be critical to helping our customers feel weve delivered on our promise. That means building on our reputation for top-notch service from the industry leader. We need your Next-Level Service Mindset at Bug House! As part of the...

  • Customer Service Representative

    3 weeks ago

    Milledgeville, United States DCC Propane, LLC Full time

    Job DescriptionJob DescriptionThe primary purpose of this position is to provide exemplary customer service to customers. Responsible for helping customers by providing product and service information in a confident, friendly, and articulate manner. Duties may also include upselling as well as other inside sales responsibilities as assigned. Will be the...

  • Customer Service Representative

    3 weeks ago

    Milledgeville, United States Domino's Franchise Full time

    Job DescriptionJob DescriptionJob DescriptionABOUT THE JOBYou got game? You got spring in your step? You want the best job in the world! And schedules that work with you, not against you? That's right, we live to beat the rush and make it possible to make, bake or take pizzas during the hungry hours of the day and night, part or full time. You'll...

  • Part-Time Social Service Provider-Milledgeville YDC- Milledgeville, GA

    3 weeks ago

    Milledgeville, United States GeorgiaGov Full time

    Job Summary – Under broad supervision, provides rehabilitation counseling services, referral services, and resident evaluation to assigned clients. This position is part-time hourly and requires less thank 30 hours per week and is not eligible for benefits. Responsibility 1 Performs and/or directs intake services to youth 1.Performs or directs...

  • Insurance and Financial Services Position

    1 month ago

    Milledgeville, United States Charlie Pelt - State Farm Agent Full time

    Job DescriptionJob DescriptionROLE DESCRIPTION:Charlie Pelt State Farm is searching for a competitive Producer who can recognize opportunities and strategically turn leads into long-lasting customer relationships. As our Multi Line Representative, your knowledge of insurance products and industry trends equips you to communicate directly with clients,...

  • Enrollment Coach Assistant: Main

    2 months ago

    Milledgeville, United States Georgia Military College Full time

    Job DetailsJob Location Main Campus - Milledgeville, GA Position Type Full Time Education Level High School Job Category Education DescriptionGeorgia Military College Milledgeville Campus is accepting applications for the position of Enrollment Coach Assistant. The Enrollment Assistant is responsible for supporting the functions of the Enrollment Office....

  • Customer Service Manager

    3 weeks ago

    Milledgeville, United States Fouts Bros Inc.Smyrna Truck Full time

    **Customer Service Manager** Fouts Bros is a family-owned business since 1952 with facilities in Georgia and Texas. Fouts Bros is proud to have become one of the largest and most diverse commercial truck manufacturers in the US. Fouts Bros is committed to developing new commercial vehicles that provide industry-best value, quality, and dependability. Our...

  • Mortgage Loan Originator

    1 month ago

    Milledgeville, United States Magnolia State Bank Full time

    Job Type Full-time Description SUMMARY The position of Mortgage Loan Originator is responsible for soliciting, negotiating, underwriting and coordinating the closing of routine residential, construction and commercial mortgage loans in compliance with the Bank's lending policies and procedures; develops business checking and deposit relationships with...

  • Mortgage Loan Originator

    3 weeks ago

    Milledgeville, United States Magnolia State Bank Full time

    Job Type Full-time Description SUMMARY The position of Mortgage Loan Originator is responsible for soliciting, negotiating, underwriting and coordinating the closing of routine residential, construction and commercial mortgage loans in compliance with the Bank's lending policies and procedures; develops business checking and deposit relationships with...

  • Physical Therapist

    3 weeks ago

    Milledgeville, United States Green Acres Health & Rehab Full time

    Join us atAll potential candidates should read through the following details of this job with care before making an application.Green Acres Health & Rehab- a place where you'll be valued, recognized and rewarded for the vital work you do each day. We'll surround you with a strong team and leadership that supports every aspect of your life - both inside and...

  • Physical Therapist

    3 weeks ago

    Milledgeville, United States Green Acres Health & Rehab Full time

    Join us at Green Acres Health & Rehab - a place where you'll be valued, recognized and rewarded for the vital work you do each day. We'll surround you with a strong team and leadership that supports every aspect of your life - both inside and outside of our centers. And you'll get to practice your passion in a non-profit, mission-driven organization that's...

  • Physical Therapist Assistant

    3 weeks ago

    Milledgeville, United States Chaplinwood Health & Rehab Full time

    Join us atIncrease your chances of an interview by reading the following overview of this role before making an application.Chaplinwood Health & Rehab- a place where you'll be valued, recognized and rewarded for the vital work you do each day. We'll surround you with a strong team and leadership that supports every aspect of your life - both inside and...