Provider Relations and Contracting Specialist

Guidehealth • Chicago, IL

19h • $48,000 - $51,000 • Remote

About The Position

This role provides critical operational support to the Client Business Manager team while assisting with day-to-day provider relations, contracting, network operations, and a wide range of client support activities. The position assists where operational help is needed to continue servicing our clients at a high level. This includes supporting contracting follow-up, responding to inquiries, handling operational aspects of the provider network, and delivering broad assistance to the assigned Client Business Manager(s) on various client-related tasks. This is a developmental role designed to deliver immediate capacity relief while building the skills and knowledge needed to eventually take on full Client Business Manager responsibilities as the organization grows.

Requirements

• 3+ years of experience in provider relations, provider contracting, network management, or client support in healthcare (health plan, IPA, MSO, or managed care strongly preferred)
• Solid understanding of provider contracting, credentialing, claims processing, authorizations, and healthcare operations
• Strong relationship-building and communication skills — equally comfortable working with providers/office staff and health plan/client leadership
• Highly organized with excellent project management, follow-through, and prioritization skills
• Proficiency with Microsoft 365 (Excel, Teams, PowerPoint) and comfort learning multiple healthcare platforms and portals
• Ability to thrive in a fast-paced, fully remote environment while collaborating across teams

Nice To Haves

• Located in or around the Chicago metro area with the ability to travel to and from client meetings as needed
• Experience supporting or working in a Client Business Manager, Account Manager, or Client Success role
• Background in value-based care or IPA network operations
• Familiarity with reimbursement models (fee-for-service, capitation, carve-outs) and network adequacy requirements
• Bachelor’s degree in healthcare administration, business, or related field.

Responsibilities

• Coordinating and providing care management and care that is timely, effective, efficient, equitable, safe, and member centered.
• Managing case assignments (outreach, documentation, case progression, and case closures), meeting reporting and documentation standards, and engaging in collaborative meetings with clients.
• Monthly attendance and coordination of UM/PHM Committee Meetings including material preparation, minutes, data collection and analysis, reporting and follow-up tasks.
• Training new and current employees with Preceptors. Re-education for audit fallouts.
• Assisting in creating, re-evaluating, and updating workflows/processes.
• Updating internal knowledge base and Confluence pages.
• Assisting in creation, re-evaluation, and analysis of necessary reporting, and identification of reporting opportunities.
• Attending and participating in virtual and in-person leadership meetings as necessary.
• Responsible for continued professional growth and education that reflects knowledge and understanding of current nursing care practice as outlined in the Illinois Nurse Practice Act.
• Other responsibilities as assigned, including assisting with payroll and monitoring FTO requests, as well as completing coaching and performance reviews with the team.
• Communication with IPA Administrators and Client Business Managers to ensure resolution of any concerns.

Benefits

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level