Provider Relations Representative

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

📋 Description

• Assess designated territories to identify gaps and opportunities for provider recruitment.

• Recruit, contract, and foster relationships with physicians, specialists, ancillary providers, and hospitals.

• Identify and approach potential providers to form contractual agreements that align with network requirements.

• Complete necessary contracting documentation, including credentialing and site evaluations.

• Conduct site assessments for newly contracted providers to ensure compliance with network and regulatory standards.

• Negotiate provider contracts and reimbursement rates utilizing claims and utilization data.

• Act as the primary contact for provider inquiries related to contracts, network participation, and Health Network One operations.

• Collaborate with contracted providers to seamlessly integrate services into the care delivery network.

• Communicate with internal departments and participating providers to facilitate network development and provider referrals.

• Assist the Credentialing Department with credentialing and re-credentialing documentation.

• Maintain precise provider files and ensure data integrity in company systems and databases.

• Analyze claims and utilization data to assess provider performance and contract profitability.

• Generate reports and summaries for senior management.

• Ensure adherence to HIPAA regulations along with company policies and procedures.

• Perform additional related duties as assigned.

⛳️ Requirements

• Associate’s degree or equivalent from an accredited two-year college or technical school, or a combination of education and experience.

• Two to three years of experience in a physician office, HMO, managed care organization, or another healthcare setting.

• Experience in provider contracting, network management, or managed care operations.

• Familiarity with claims analysis, utilization data, and provider reimbursement models.

• Ability to travel within the assigned territory based on network requirements.

• Knowledge of HIPAA regulations and company policies and procedures.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health, dental, and vision insurance packages.

• Generous paid time off and holiday schedules.

• Opportunities for professional development and continuing education.

• Collaborative and supportive work environment.