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Senior Provider Network Liaison

Company: American Health Management Services LLC
Location: Franklin
Posted on: February 22, 2021

Job Description:

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, Florida, Utah, Texas, and Mississippi, with planned expansion into other states in 2021. For more information, visit . JOB SUMMARY: The Senior Provider Network Liaison will analyze reports to determine network adequacy and market needs; educate and assist (as needed) Executive Director, Market Contract Manager, and Provider Relations Representative in existing health plan service area(s) regarding contracting and credentialing functions. This position will have provider education responsibilities including ongoing maintenance, system training, and access to resources and will review contract and credentialing packets for accuracy and completeness, maintain professional and collaborative relationships and act as a resource for current service areas for the Health Plan(s). ESSENTIAL JOB DUTIES: To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.

  • Assist with negotiation and contracting providers and essential vendors to maintain CMS adequacy and providing necessary services in the care of the Plan members
  • Educate operations field staff on contracting, credentialing, documentation, provider education; system training; and expectations and ongoing activities
  • Ensure providers and essential vendors meet the credentialing requirements for their appropriate service lines
  • Perform analysis of the Health Plan(s) provider network to maintain network adequacy on an ongoing basis
  • Understand, educate and discuss basic financial analysis of current or potential contracts and payment arrangements with providers and their appropriate staff
  • Establish a positive work environment that encourages participation in process improvement and commitment to department/company success
  • Complete corporate assignments as assigned JOB REQUIREMENTS:
    • Must be fluent in all current provider payment methodologies
    • Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships
    • Must have strong negotiation, organization, presentation and time management skills
    • Excellent computer skills, including Microsoft Office Suite
    • Current automobile insurance according to company policy REQUIRED QUALIFICATIONS:
      • Education:
        • Bachelor's degree with an emphasis in Healthcare Administration/related field preferred or three years of experience in managed care network development/network services
        • 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 SUPERVISORY RESPONSIBILITES:
            • Does not have supervisory responsibilities 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. Education Preferred
              • Bachelors or better in Health Services Administration or related field - provided by Dice

Keywords: American Health Management Services LLC, Franklin , Senior Provider Network Liaison, Other , Franklin, Tennessee

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