Provider Relations Analyst

Location: Calmont Operations Building, First Shift (40 hours per week)

About the role

This position reports directly to the Manager of Provider Relations and serves as the primary liaison between the physician community and Provider Relations staff. Responsibilities include maintaining effective relationships with providers, facilitating physician education, and resolving complex, urgent issues.

Responsibilities

• Act as the focal point for providers and provider offices, ensuring effective communication and relationship management.
• Facilitate and resolve complex, urgent problems for the physician community.
• Coordinate and facilitate provider and committee meetings.
• Create and publish newsletters and notifications for providers.
• Monitor Managed Care Organization (MCO) notices.
• Resolve provider complaints and issues.
• Update and audit the provider website.
• Update codes on the prior authorization lookup tool.
• Manage emails and CRMs for the Provider Relations inbox.
• Handle special projects as assigned by Provider Relations and Network Management Director.
• Maintain familiarity with Texas Medicaid and claims resolution processes.

Requirements

• Bachelor’s degree preferred, but 10 years of healthcare/provider and/or member services experience may be considered in lieu of a degree.
• 1-2 years of experience in a provider or member services role, preferably working with state regulatory agencies.
• Familiarity with the provider community and experience presenting in public settings.
• Medical billing and healthcare industry knowledge is a plus.
• Basic understanding of CHIP & STAR benefits, and NPI/TPI relationships for billing.
• Working knowledge of HMO business operations, including member services, claims, credentialing, and plan operations.
• Proficiency with Microsoft Office Suite (Outlook, Excel, Word, PowerPoint).