Health Plan Provider Relations Representative

Our client operates within the healthcare industry, focusing on managed care and health plan services. They address challenges related to provider network development, adequacy, and education to ensure effective partnerships and compliance with health plan policies and regulations. The organization engages with a broad range of healthcare providers to support service quality and regulatory adherence.

About the Opportunity

The Health Plan Provider Relations Representative plays a critical role in managing relationships between the health plan and its contracted providers. This position ensures provider satisfaction, facilitates education on key initiatives, and promotes compliance with organizational policies. The role supports network management by enhancing communication, resolving issues, and improving provider engagement, directly impacting service delivery and member experience.

Responsibilities

• Engage with high-volume, high-visibility plan providers to ensure satisfaction and education on key initiatives.
• Serve as the primary contact for non-complex providers within the network.
• Educate and advocate for providers to ensure compliance with policies and high customer service standards.
• Conduct regular provider site visits to assess compliance and service quality.
• Provide on-the-spot training and maintain positive provider relationships.
• Troubleshoot and resolve provider issues proactively.
• Coordinate problem-solving meetings involving providers and internal stakeholders.
• Deliver training and presentations to providers and their staff.
• Monitor policy enforcement and promote participation in quality and cost-effectiveness initiatives.
• Support training for new and existing provider relations team members.
• Commit to 60% or more travel within the service area.

Requirements

• Minimum of 2 years experience in customer service, provider services, or claims within managed care or medical office settings.
• General understanding of healthcare delivery and government-sponsored health plans.
• Strong organizational and multitasking skills.
• Effective interpersonal and communication skills.
• Ability to work in a matrixed, cross-functional environment.
• Proficiency with Microsoft Office and relevant software.
• Preferred: Familiarity with managed care provider compensation methodologies.
• Preferred: Experience delivering training and educational presentations.