Provider Relations Representative

About the role

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations through advanced value-based models. The Provider Relations Representative is critical to the overall success of the Company, ensuring new and established participating providers receive great service and maintenance throughout the term of their agreement. This role requires consistent telephonic, face-to-face, and written communication to establish and retain positive relationships with the participating provider network.

The ideal candidate will be relationship-oriented, with an outgoing personality, attention to detail, and a firm understanding of the healthcare delivery system. A collaborative, advising, and attentive attitude is essential, along with a professional appearance.

Responsibilities

• Assist with investigating and resolving administrative issues and concerns between AZPC, the provider network, and health plans.
• Develop and maintain provider relationships, serving as the primary resource for internal staff and the provider network by conducting regular physician office visits to ensure open communication.
• Ensure providers receive timely and accurate information regarding organization initiatives, services, programs, policies, procedures, and quality measurements.
• Keep AZPC Administration informed of any provider or health plan issues/concerns and support timely communication and resolution.
• Coordinate in-office support, including written and oral communication with providers, preparation and distribution of packets, and handling incoming phone calls and emails.
• Assist with verification of provider effective dates, termination dates, open/closed panel status, demographic information, and health plan identification numbers.
• Communicate and interact effectively with PCPs, Specialists, and contracted vendors/services through coordination and attendance at regular Office Manager meetings.
• Ensure Provider Relations department goals are achieved and improve quality and business processes for the assigned territory.
• Manage qHMO, AZ Connect, EzNet, and other AZPC systems user accessibility for the provider network.
• Assist with marketing AZPC by attending and participating in employer group events.
• Coordinate the HCC program within the participating provider network, including assisting with ICD and CPT coding for billing as assigned.
• Review and report statistical data for potential chart review/audit of the participating provider network.
• Maintain a structured process for quality audits, tracking, and trending, including monitoring provider network progress on the HCC Concurrent program and coordinating further trainings with the HCC Department.
• Maintain detailed and accurate provider contact notes.
• Travel significantly in your personal vehicle to local provider offices and events.
• Handle special projects and other duties as assigned by management.

Requirements

• Associate’s Degree or related equivalent experience – Required.
• Prior experience with Network Contracting with physicians.
• Proficient in office equipment (computers, printers, etc.) and Microsoft Office programs (Word, Excel, PowerPoint, Access, and Outlook).
• EzCap experience a plus.
• Excellent written and verbal communication skills.
• Ability to maintain confidentiality.
• Ability to multi-task and prioritize in a high-stress environment.
• Strong decision-making and problem-solving skills, using logic to identify key facts, explore alternatives, and propose quality solutions.
• Ability to gather and collect information or data effectively.
• Preferred knowledge of CPT, ICD, HCPCS, and HCC coding; training available for the right candidate.
• Knowledge of qHMO & EzCap – Preferred.
• Must interact with providers professionally and represent the company positively.
• Current unrestricted Arizona Driver’s license, reliable transportation, and proof of insurance required.

Schedule

This role requires 60 days of full-time in-office presence. Hybrid options will be available after the 60-day period.

Pay

The compensation range for this role is $60,000 – $65,000.