Provider Relations Representative

American Health Plans seeks a Provider Relations Representative to join our Sales & Business Development team. In this role, you'll build and manage strong relationships with healthcare providers, support contract negotiations, and ensure network satisfaction with our comprehensive insurance solutions. You will collaborate cross-functionally to resolve provider issues, optimize service quality, and support growth initiatives. We value integrity, innovation, and customer-centric service, offering opportunities to contribute to meaningful health outcomes while advancing your professional development in an inclusive, team-focused environment.

Responsibilities

• Serve as primary liaison for an assigned panel of healthcare providers, ensuring strong, collaborative relationships.
• Onboard new providers, supporting credentialing, contracting, and integration into American Health Plans' networks and systems.
• Educate providers on plan products, policies, prior authorization processes, and provider portals to support smooth operations.
• Investigate and resolve provider concerns related to claims, reimbursement, and administrative processes, escalating as needed.
• Review provider performance, utilization, and access data to identify opportunities to improve network quality and adequacy.
• Support Sales and Business Development initiatives by promoting network participation and communicating the value of American Health Plans' offerings.
• Conduct periodic in-person and virtual provider visits and trainings within the assigned territory.
• Collaborate with internal teams to address systemic issues, recommend process improvements, and enhance the overall provider experience.
• Maintain accurate records of provider interactions and activities in CRM and tracking systems.
• Represent American Health Plans professionally at provider meetings, conferences, and industry events.

Required Skills

• Provider relationship management
• Healthcare contract negotiation support
• Knowledge of managed care and reimbursement models
• Claims and billing issue resolution
• Data analysis and reporting
• CRM and provider network management software
• Presentation and training delivery
• Territory and account management
• Sales and business development support
• Knowledge of HIPAA and healthcare regulations