Provider Relations Representative

About Our Client

The organization operates within the healthcare sector, specifically managing the World Trade Center Health Program (WTCHP). It addresses the challenge of ensuring effective coordination and communication between healthcare providers and the program, facilitating access to care for affected populations. The organization supports multiple operational areas to maintain high-quality provider experiences and program integrity.

About the Opportunity

The Provider Relations Representative serves as the primary liaison between the healthcare program and participating providers. This role is pivotal in onboarding, educating, resolving issues, and managing relationships to enhance provider engagement and satisfaction. The position ensures seamless operational support to maintain program quality and provider participation.

Responsibilities

• Act as the primary contact for assigned providers, conducting regular communications and check-ins.
• Monitor provider satisfaction; identify issues and develop improvement plans.
• Document all provider interactions accurately in case management systems.
• Manage end-to-end provider onboarding, including portal setup and credentialing coordination.
• Standardize onboarding processes and monitor progress to prevent delays.
• Deliver targeted provider training and maintain updated educational materials.
• Resolve escalated provider issues related to claims, credentialing, enrollment, and portal access.
• Promote and support use of portal features and electronic funds transfer (EFT) enrollment.
• Collaborate with cross-functional teams to address provider needs and improve processes.
• Maintain performance dashboards and analyze trends to guide outreach and improvements.
• Ensure compliance with policies and maintain audit-ready documentation.

Requirements

• Bachelor’s degree preferred.
• Minimum of 3 years’ experience in provider relations, provider services, or health plan operations.
• Strong skills in communication, presentation, facilitation, and relationship management.
• Proficiency with provider portals, CRM/case management tools, and spreadsheet software.
• Ability to manage multiple priorities, meet service level agreements, and produce clear documentation.
• Preferred: experience with federal or government-sponsored healthcare programs.
• Preferred: familiarity with claims operations, EDI, credentialing, and provider directory standards.
• Preferred: Lean/Six Sigma or project management certification.

Pay Range and Compensation Package

The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, and other relevant factors.