Provider Relations Representative

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

📋 Description

• Act as the primary contact for designated providers.

• Conduct regular provider interactions and executive-level check-ins/QBRs as necessary.

• Monitor provider sentiment and satisfaction while implementing action plans.

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

• Oversee the complete provider onboarding and orientation process.

• Manage portal registration and EFT configuration.

• Standardize onboarding checklists, timelines, and transitions.

• Track onboarding milestones and eliminate obstacles.

• Provide training for providers through webinars, welcome packets, and job aids.

• Keep FAQs, guides, and reference materials updated.

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

• Conduct root-cause analysis and ensure remediation is tracked to completion.

• Advocate for portal self-service workflows and assist with troubleshooting.

• Enhance EFT adoption and support banking/EFT data verification and updates.

• Collaborate cross-functionally with Provider Data, Credentialing, Contracting, Claims, Finance, Clinical Operations, Communications, and IT.

• Represent provider interests in workgroups and report measurable outcomes.

• Maintain dashboards and logs for satisfaction, resolution, onboarding, case aging, portal adoption, and SLA compliance.

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

• Ensure audit-ready documentation and protect provider information.

⛳️ Requirements

• Minimum of 3 years in provider relations/provider services or health plan operations.

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

• Proficient in using provider portals and CRM/case management tools.

• Strong skills in Excel/Sheets.

• Capability to manage multiple priorities, adhere to SLAs, and produce clear documentation.

• Bachelor’s degree is preferred.

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

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

• Lean/Six Sigma or project management certification (e.g., Green Belt, PMP) is preferred.

• US citizenship is not a requirement.

• Travel requirements are less than 10%.

🏝️ Benefits

• Flexible work week.

• 401(k) plan with company matching.

• Comprehensive health and wellness packages.

• Support for internal mobility.

• Paid education and certification opportunities.

• Opportunities for professional growth.

• Paid vacation and holidays.

• Medical plan options, including those with Health Savings Accounts.

• Dental plan options.

• Vision plan.

• Paid sick and personal time off.

• Paid parental, military, bereavement, and jury duty leave.

• 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.