Provider Relations Representative

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as the main contact for designated providers, conducting regular check-ins and executive-level quarterly business reviews as required.

• Monitor provider sentiment and satisfaction, identify trends, and develop action plans in collaboration with the Provider Network Supervisor.

• Record all interactions, decisions, and follow-ups in CRM or case management systems.

• Manage the complete provider onboarding process, which includes preparing welcome materials, registering on the portal, setting up EFT, handling credentialing transitions, and validating directories.

• Track onboarding milestones, eliminate obstacles, and communicate progress and next steps.

• Provide training to providers through webinars, welcome packets, and job aids covering policies, billing requirements, and operational procedures.

• Maintain FAQs, guides, and reference materials that are updated according to process changes.

• Address escalated provider issues related to claims, credentialing, EFT, enrollment, and portal access.

• Assess and route issues, keep providers informed about resolution status and root causes, and ensure follow-up until closure.

• Conduct root-cause analysis for recurring issues and recommend corrective actions.

• Promote portal functionalities and self-service workflows, assisting with registration, user management, navigation, and troubleshooting.

• Enhance EFT adoption and coordinate the verification and updating of banking/EFT information.

• Work collaboratively with Provider Data, Credentialing, Contracting, Claims, Finance, Clinical Operations, Communications, and IT teams.

• Advocate for provider needs in workgroups, ensure action items are completed, and report on measurable outcomes.

• Maintain dashboards and logs tracking satisfaction, first-contact resolution, onboarding timelines, case aging, portal usage, and SLA compliance.

• Analyze trends and contribute to ongoing improvement initiatives, including templates, scripts, and automation efforts.

• Ensure compliance with policies and regulations, maintain audit-ready documentation, protect provider information, and support audits and corrective action strategies.

⛳️ Requirements

• Minimum of 3 years of relevant experience.

• Proficient in business operations, data management, problem-solving, and reporting.

• Availability for a full-time schedule of 40 hours per week.

• Willingness to travel less than 10% of the time.

• No security clearance required.

• US citizenship is not a requirement.

• Capability to complete identity verification using biometrics and artificial intelligence.

• Must be on camera during virtual interviews.

🏝️ Benefits

• Options for medical plans, including those with Health Savings Accounts.

• Choices for dental plans.

• Vision plan availability.

• 401(k) plan with pre-tax and post-tax contributions up to IRS annual limits and company matching.

• Flexible work weeks whenever possible.

• Paid vacation, sick leave, and personal time.

• Paid holidays.

• Paid parental leave.

• Military leave.

• Bereavement leave.

• Jury duty leave.

• Typically offers 15 days of paid leave each calendar year.

• An additional 10 paid holidays per year.

• Up to 160 hours of paid family leave within a rolling 12-month period for eligible employees.

• Short- and long-term disability benefits.

• Life insurance coverage.

• Accidental death and dismemberment insurance.

• Personal accident insurance.

• Critical illness insurance.

• Business travel and accident insurance.

• Option to work remotely.