- 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
- 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
- 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
- Bachelor's degree preferred, but not required, with emphasis in Healthcare Administration/related field or three (3) years of experience in managed care network development/network services
- 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
- Microsoft Suite including Outlook, Excel, and Word
- Standard Office Equipment
- Computer
- Allows discretion for standing, walking, sitting
- Work is performed in a standard office environment; well-lit; comfortable temperature controlled; average conversational noise is frequent
- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
- Working safely and follow safety rules
- Report unsafe working conditions and behaviors
- Take reasonable and prudent actions to prevent others from engaging in unsafe practices
- Does not have direct supervisory responsibilities
- Supervisor frequently determines priorities
- Occasionally needs manager's direction due to extraordinary circumstances
-
Provider Relations Representative
2 weeks ago
American Health Plans Boise, United StatesAmerican 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 plan ...
-
Employee Relations Representative
3 weeks ago
Idaho State Job Bank Boise, United StatesEmployee Relations Representative at Sunrun in Boise, Idaho, United States Job Description Everything we do at Sunrun is driven by a determination to transform the way we power our lives. We know that starts at the individual employee level. We strive to foster an environment you ...
-
Provider Relations Representative
2 weeks ago
American Health Plans Inc. Boise, United StatesAmerican 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 plan ...
-
Senior Employee Relations Representative Senior
19 hours ago
Idaho State Job Bank Boise, United StatesSenior Employee Relations Representative Senior at St. Luke's Health System in Boise, Idaho, United States Job Description Overview St. Luke's Health System in Boise, ID is seeking an Senior Employee Relations Representative to join our Employee Relations Team. Summary: The Senio ...
-
Customer Relations Representative
1 day ago
Shauna Mickens - State Farm Agent Kuna, United StatesPosition 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 financi ...
-
Customer Solutions Representative
3 weeks ago
Kforce Inc. Boise, United StatesRESPONSIBILITIES: · Kforce is immediately adding a full-time Customer Solutions Representative in support of our nationally recognized, Consumer and Commercial Electronic R&D client in Boise, ID.Responsibilities: Customer Solutions Representative will be responsible for validatin ...
-
Technical Sales Representative
6 days ago
Azelis Idaho, United States Full timeAzelis Agricultural & Environmental Solutions (A&ES) is seeking a talented and experienced Technical Sales Representative to join our vector team. This position is responsible for contacting and calling on all existing and potential customers in the representative's assigned Midw ...
-
IT Specialist
2 weeks ago
U.S. Department of the Interior Boise, United StatesClarification from the agency · All current career/career-conditional or former federal employees with reinstatement eligibility; Veterans' Employment Opportunity Act (VEOA); Land Management Workforce Flexibility Act (LMWFA); former Public Land Corps (PLC) eligibles; and Persons ...
-
Director of College Sales, Western Region
2 weeks ago
SA Recycling Idaho, United States Full timeThe Director of Sales is responsible for meeting and exceeding annual financial and net sales goals for BFW products to be marketed within a defined geographic area of the US consisting of several sales regions. Director of Sales is responsible for managing the regional managers ...
-
Sales Representative
2 weeks ago
Pacific Coast Building Products Boise, United StatesRESPONSIBILITIES · : include the following. Other duties may be assigned. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Visit assigned stores to further industry and product specific education, confirm that com ...
-
Natural Gas Marketer
3 weeks ago
BP Boise, United StatesGrade HResponsible for supporting the origination, structuring and execution of transactions, ensuring that origination activities are rigorously executed in accordance with the relevant standards, supporting the approval and assurance process and drives interaction with support ...
-
Senior Conversational AI Developer
2 weeks ago
Live Nation Worldwide, Inc. Idaho, United States Full timeTHE JOB · Ticketmaster, a global leader in live event ticketing, is seeking an experienced Senior Developer to join our dynamic team. This role is instrumental in developing and enhancing our customer service capabilities through the implementation and improvement of AI-powered ...
-
Human Resources Generalist
2 weeks ago
Swire Coca-Cola Boise, United StatesResponsibilities · : Represent Employees Be present. Spend time with employees. Build relationships with them and get to know themSupport employees in day-to-day HR operational matters (such as onboarding, HR process execution, training, etc.) · Support Managers Coach and suppor ...
-
Cabinet builder and installer
1 week ago
Furniture Medic by Beringer Restoration Boise, United States Full timeBenefits:Competitive salary · Opportunity for advancement · Paid time off · Furniture Medic is looking for a self-motivated individual to assist in building, repairing and installing cabinetry This position also requires on site visits to both residential and commercial customers ...
-
Environmental Engineer Lead
2 weeks ago
Micron Boise, United StatesOur vision is to transform how the world uses information to enrich life for all. · Micron Technology is a world leader in innovating memory and storage solutions that accelerate the transformation of information into intelligence, inspiring the world to learn, communicate and ...
-
Director Finance Remote
1 week ago
Providence Idaho, United States Full timeProvidence is calling a Director Finance who will: · Be responsible for the financial oversight of assigned ministries including but not limited to: Knowledgeable on High Performing Network Financial Analysis Monitoring financial performance Variance reporting Supporting the ach ...
-
Staff Engineer
2 weeks ago
IDAHO AGC BENEFIT PLAN TRUST Boise, United States· STRATA provides clients with professional geotechnical engineering, construction inspection, and material testing (CMT) services throughout the intermountain west. Currently, STRATA has offices in Boise, Hayden, Twin Falls, Idaho Falls, and Pocatello, Idaho; and Spokane, Washi ...
-
Regional Property Manager
2 weeks ago
Peak Living Boise, United StatesPeak Living is currently seeking a qualified Regional Manager to join our team · Under the direction of the Regional Vice President, the Regional Manager assists in the development and monitoring of company policies and procedures related to property management; recruits, trains, ...
-
Senior Construction Manager
2 days ago
Exyte Boise, United StatesYour vision is ambitious · . Just like ours. Our people are our success. As one of us, you will contribute to engineering excellence for the high-tech markets of the future, including semiconductors, batteries, pharmaceuticals, biotechnology, and data centers. At Exyte, you wil ...
-
Direct Bill Service Representative
1 week ago
USLI Boise, United States Full time· Essential Functions: · Service incoming telephone calls regarding billing and payment inquiries in accordance with team standards, perform research and follow up to effectively respond to calls and online communication within established service promises, document call log in ...
Provider Relations Representative - Boise, United States - American Health Partners
![Default job background](https://contents.bebee.com/public/img/bg-user-ex-1.jpg)
Description
American Health Plans manages institutional special needs plans (I-SNPs) in nursing homes in several states by sharing plan ownership with the facilities.
We currently own one of the oldest provider-owned I-SNPs in the country and are rapidly developing new partnerships with nursing home owners.
Today, you can find our managed care plans in 123 nursing homes, and we are rapidly developing new partnerships with nursing home owners.
POSITION SUMMARY:
The purpose of this position is to 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 FUNCTIONS:
To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation
Required Skills:
Required Work Experience:
Licensing/Certification/Education Requirements:
Other Requirements:
Required Computer Software/Equipment Used:
Physical Requirements:
Required Safety Expectations:
Supervisory Responsibilities: