Provider Relations Specialist

4 weeks ago


Pittsburgh, Pennsylvania, United States American Health Plans Full time

About the Role:

The Provider Relations Representative will play a key role in analyzing market needs, performing contracting functions, educating providers, and maintaining business relationships for American Health Plans. This position requires strong negotiation, organization, presentation, and time management skills, as well as the ability to effectively communicate with all levels of medical staff.

Key Responsibilities:

  • Contracting providers and essential vendors to maintain CMS adequacy and provide necessary services
  • Ensuring providers meet credentialing requirements for their service lines
  • Providing ongoing educational updates as prescribed by CMS and American Health Plans policies
  • Maintaining and supporting provider relationships to ensure network coverage

Requirements:

  • Experience in the healthcare field, with prior experience in network development/network services preferred
  • Strong negotiation, organization, presentation, and time management skills
  • Ability to effectively communicate with all levels of medical staff
  • Excellent computer skills, including Microsoft Office Suite

What We Offer:

  • Affordable medical/dental/vision insurance options
  • Generous paid time-off program and paid holidays
  • TeleDoc 24/7/365 access to doctors
  • Optional short- and long-term disability plans
  • Employee Assistance Plan (EAP)
  • 401K retirement accounts with company match
  • Employee Referral Bonus Program

Work Environment:

This position requires travel to network provider locations and working in a standard office environment. The physical demands of this job include standing, walking, and sitting, with occasional need for manager's direction due to extraordinary circumstances.



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