Job Details

Job Description:

Pay Range: $24.88hr - $32.88hr

• The Provider Relations Representative will be responsible for supporting providers through education, relationship management, and issue resolution to ensure quality service delivery and positive member interactions.
• This role partners with the Provider Training and Education Department, provides analytical support, and acts as a liaison between providers and internal departments to ensure smooth operational and contractual alignment.

• Partner with the Provider Training and Education Department to educate providers on programs, processes, and electronic tools.
• Provide targeted training to help providers successfully navigate the provider portal and follow company procedures.
• Support one or more health systems representing multiple practices to ensure Tier One Service delivery.
• Provide research, analytical, and resolution support for special projects and complex cases.
• Respond verbally or in writing to inquiries from management, internal teams, and external customers.
• ssist providers in resolving escalated service-related issues and inquiries through face-to-face visits, correspondence, email, and phone.
• Build and maintain strong relationships with providers through regular communication and timely problem resolution.
• Proactively identify provider needs and address them through problem solving and collaboration with internal and external resources.
• Leverage provider relationships to drive and influence provider behavior towards favorable outcomes.

• High school diploma or equivalent.
• Minimum of 4 years of experience in the healthcare industry, including experience with providers, training, claims, customer service, and presentations.

• Experience working with providers in a managed care or insurance environment.
• Experience in training and educating provider networks.
• Experience handling provider issues and resolving escalations.

• Bachelor's degree in Business, Healthcare Administration, or a related field preferred.
• Previous experience with a Client Client plan, insurance organization, hospital, or physician hospital organization (PHO).

• Proficient knowledge of provider billing and coding mechanisms.
• Strong understanding of managed care industry regulations and third-party payment methodologies.
• bility to interpret and communicate contractual documents effectively.
• Proficiency in Microsoft Excel, Access, PowerPoint, and Word.
• Excellent communication and relationship management skills.
• Strong analytical and problem-solving abilities.

• High school diploma required.
• Bachelor's degree in Business, Healthcare Administration, or related field preferred.