Provider Relations Representative

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

📋 Description

• Act as the main liaison and account manager for designated healthcare providers.

• Facilitate provider interactions and conduct executive-level check-ins/QBRs as necessary.

• Oversee the complete provider onboarding process, which includes welcome materials, portal registration, EFT setup, credentialing handoffs, and directory validation.

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

• Provide training on program policies, billing requirements, and operational procedures.

• Keep FAQs, guides, job aids, and reference materials up to date.

• Address and escalate provider concerns related to claims, credentialing, EFT, enrollment, and portal access.

• Conduct root-cause analysis and monitor corrective actions until resolution.

• Encourage portal self-service workflows and enhance EFT adoption rates.

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

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

• Evaluate trends and contribute to process enhancements, templates, scripts, and automation initiatives.

• Ensure audit-ready documentation and protect provider data.

• Assist with audits and the implementation of corrective action plans.

⛳️ Requirements

• A minimum of 3 years in provider relations/provider services or health plan operations, encompassing onboarding, education, or issue resolution.

• Excellent communication, presentation, facilitation, and relationship management abilities.

• Proficient in provider portals and CRM/case management systems.

• Strong skills in Excel/Sheets.

• Capable of handling multiple priorities, adhering to SLAs, and generating clear documentation.

• Experience with federal or government-sponsored healthcare programs is preferred.

• Knowledge of claims operations, EDI, credentialing prerequisites, and provider directory standards is preferred.

• Lean/Six Sigma or project management certifications, such as Green Belt or PMP, are preferred.

• A Bachelor’s degree is preferred.

🏝️ Benefits

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

• Dental plan options available.

• Vision plan offered.

• 401(k) plan with pre-tax and post-tax contributions and a company match.

• Flexible work weeks where feasible.

• Paid vacation, sick, personal, holiday, parental, military, bereavement, and jury duty leave.

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

• 10 paid holidays annually.

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

• Short- and long-term disability benefits provided.

• Life insurance coverage.

• Accidental death and dismemberment insurance.

• Personal accident insurance.

• Critical illness insurance available.

• Business travel and accident insurance included.

• Remote work options.