Provider Relations Representative

About the role

The Provider Relations Representative serves as a key day-to-day contact between Umpqua Health (UH) and its contracted providers. This position builds and maintains positive working relationships, responds to provider questions, conducts provider visits and orientations, and supports satisfaction and engagement across the network.

Responsibilities

• Serve as a primary point of contact for assigned providers, building and maintaining positive, professional relationships
• Respond to provider questions and help resolve issues related to claims status, eligibility, benefits, authorizations, and plan processes, escalating complex matters as appropriate
• Conduct provider visits, orientations, and check-ins, both in person and virtual, to support satisfaction and engagement
• Track and document provider interactions, issues, and resolutions in the appropriate systems
• Support the onboarding of newly contracted providers and communicate changes that affect providers
• Deliver provider education and training on plan policies, processes, the provider portal, and self-service tools
• Interpret and clarify UH policies and procedures for providers and their staff
• Distribute provider communications and updates, and confirm provider understanding
• Analyze and monitor Secret Shopper calls
• Support the provider survey process and relay provider feedback to the Provider Relations Manager and subcommittees
• Support the accuracy of provider information in the Provider Directory and Provider Manual by identifying and reporting needed updates
• Help identify network access gaps and potential providers, and refer them to the appropriate team
• Support regulatory and contractual requirements relevant to assigned providers, including timely documentation and reporting
• Develop and maintain subject-matter knowledge in the assigned area (Generalist, Oral Health, Behavioral Health, or HRSN)
• Build and maintain relationships within the assigned provider or community-partner community
• For lead assignments, provide onboarding and peer training, answer day-to-day operational questions, help direct and prioritize team assignments, and serve as a go-to resource for complex workflows while remaining a non-supervisory individual contributor
• Identify problems, develop solutions, and implement chosen courses of action within the scope of the role

Qualifications

• Bachelor’s degree in related field, or equivalent experience
• 3 years of provider relations, healthcare administration, health plan operations, or related field
• Knowledge of health plan operations, Managed Care, Coordinated Care Organizations
• Advanced proficiency in Microsoft Office tools, capability to learn new software
• Proficiency in data collection, survey analysis and performance reporting
• Detail oriented, able to multitask and prioritize multiple competing deadlines
• No suspension/exclusion/debarment from participation in federal health care programs (eg. Medicare/Medicaid)
• Specialization-specific experience for specialized assignments:
• Oral Health: 3 years’ experience with dental providers or dental benefits
• Behavioral Health: 3 years’ experience with mental health or substance use disorder providers, and familiarity with 42 CFR Part 2
• HRSN: experience working with community-based organizations or social-services providers
• Lead specialization assignments: demonstrated advanced knowledge in the assigned specialization, experience training or onboarding peers, and the ability to provide day-to-day guidance and coordinate work assignments without supervisory authority

Preferred Qualifications

• Project management experience
• Ability to work independently and take the lead on assigned projects
• Team players with a collaborative mindset and commitment to health equity and community care
• Proficient computer skills, including MS Office suite
• Experience considering the impacts of the work on multiple communities, including communities of color, in technical analysis
• Experience working on a diverse team
• Experience working with different communication styles
• Bi-lingual translation or translation capabilities a plus

Schedule

Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines.

Benefits

Salary is dependent on skills, experience, and education
Generous benefits package including vacation PTO, sick leave, federal holidays, and birthday leave
Medical, dental, and vision insurance
401(k) with company match (fully vested immediately)
Company-sponsored life insurance and additional benefits
Fitness reimbursement program
Tuition reimbursement and more