Provider Relations Manager- CHS IPA

Description

The Provider Relations Manager plays a key role in supporting the contracting and credentialing operations of CHS IPA. This position partners closely with Business Development Managers and other internal teams to ensure timely onboarding, compliance, and engagement of network providers. The coordinator serves as a vital liaison between COPE Health Solutions and its provider community, helping to strengthen relationships and ensure operational excellence across the IPA network.

Reporting & Analytics

• Maintain provider recruitment, contracting, credentialing, and onboarding reports.
• Develop dashboards and reports within Salesforce to monitor:
  • Contracting pipeline
  • Credentialing status
  • Provider onboarding
  • Network growth
  • Provider engagement
  • Network adequacy
• Identify workflow bottlenecks and recommend operational improvements.

Reporting & Analytics

• Enter and update provider demographic, contract, and credentialing data in CRM/roster systems.
• Generate weekly/monthly reports on contract pipeline, credentialing status, and onboarding progress.
• Flag potential delays or risks in contracting/credentialing workflows for BDM and leadership review.
• Ensure accuracy of provider data for network adequacy reporting and payer submissions.
• Support internal and external audits by providing documentation and status updates.

Data Entry & Reporting

• Monitor expirables (licenses, DEA, malpractice, etc.) and send reminders ahead of deadlines.
• Ensure all provider records comply with internal policies, payer requirements, and audit standards.
• Support internal and external audits by providing documentation and status updates.

Compliance & Quality Assurance

• Monitor expirables (licenses, DEA, malpractice, etc.) and send reminders ahead of deadlines.
• Ensure all provider records comply with internal policies, payer requirements, and audit standards.
• Support internal and external audits by providing documentation and status updates.

Provider Issue Resolution

• Respond to provider questions regarding contracting, credentialing, claims routing, provider portals, operational workflows, and participation requirements.
• Research and resolve provider issues by collaborating with internal departments and delegated vendors.
• Escalate complex operational or contractual issues to leadership when appropriate.
• Monitor provider satisfaction and recommend process improvements.

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or related field preferred.
• Five (5) or more years of experience in provider relations, provider network management, managed care, IPA/MSO operations, provider contracting, or credentialing.
• Experience working with delegated provider networks, health plans, IPAs, MSOs, or medical groups preferred.
• Working knowledge of CMS, NCQA, DHCS, Medicare Advantage, Medi-Cal, commercial managed care, and delegated model operations.
• Experience using Salesforce or similar CRM platform strongly preferred.
• Proficiency with Microsoft Office Suite, including Excel and PowerPoint.

Benefits

As a firm passionate about health care, we’re deeply committed to the health and wellness of our own team members. We offer comprehensive, affordable insurance plans for our team and their families, and a host of other unique benefits, such as a yearly stipend for wellness-related activities and a paid parental leave program. You can learn more about our benefits offerings here: https://copehealthsolutions.com/careers/why-cope-health-solutions/.

About COPE Health Solutions

COPE Health Solutions is a national tech-enabled services firm powering success for health plans and for providers in risk arrangements. Our comprehensive NCQA certified population health management platform and highly experienced team brings deep expertise, experience, proven tools, and processes to improve financial performance and quality outcomes for all types of payers and providers. CHS de-risks the roadmap to advanced value-based payment and improves quality and financial performance for providers, health plans and self-insured employers. For more information, visit CopeHealthSolutions.com.

To Apply

To apply for this position or for more information about COPE Health Solutions, visit us at https://copehealthsolutions.com/careers/open-positions/.