Provider Relations Coordinator

Acentra Health, LLC•UNAVAILABLE, UNAVAILABLE

About The Position

Acentra Health is seeking a Provider Relations Coordinator to support provider recruitment, enrollment, onboarding, and ongoing provider relations activities. The position serves as a liaison among providers, clients, and internal teams, assisting with inquiries, claims and payment concerns, contract coordination, and provider education. It also supports network reporting, accurate documentation, and continuous improvement of provider services to promote operational efficiency and positive provider relationships. The coordinator conducts provider outreach; supports onboarding, screening, and enrollment; helps maintain provider participation; reviews and prepares provider contracts; and responds to provider and client questions. The role also handles service escalations, claims appeals, grievances, and payment disputes; maintains records and network data; tracks outreach and coverage; prepares client reports; maintains policy documentation; and provides training. The coordinator collaborates with technical teams on billing-code configuration and reimbursement methodologies, follows corporate policies including HIPAA requirements, and performs other duties as assigned. The position requires a high school diploma or equivalent and at least two years of provider-facing healthcare experience, along with working knowledge of medical coding and claims fundamentals, basic familiarity with Medicare and Medicaid payment rules, and proficiency in Microsoft Office. A bachelor's degree, advanced knowledge of Medicare claims payment rules, and clinical coding certification are preferred. The pay range is USD $24.69–$30.87 per hour.

Requirements

High school diploma or equivalent.
At least 2 years of provider-facing healthcare experience, such as health plan/provider relations, medical billing, claims adjudication, or revenue cycle management, including resolving provider inquiries about claims, pricing, and payments.
Working knowledge of medical coding and claims fundamentals, including CPT/HCPCS procedure codes, ICD-10 diagnosis codes, and familiarity with EOBs and 835/837 transaction concepts.
Basic familiarity with Medicare and Medicaid payment rules relevant to provider claims.
Proficiency in Microsoft Office applications, including Outlook, Excel, and Word, and accurate data-entry skills.
Excellent verbal and written communication, negotiation, and customer service skills, including the ability to explain provider enrollment processes and associated documentation.
Strong organizational and time-management skills, attention to detail, and ability to manage multiple priorities and meet deadlines.
Ability to handle confidential business information and protected health information (PHI) with discretion.
Ability to read and interpret benefits and account information related to customized products.
Strong problem-solving skills, sound judgment, and ability to make independent decisions.

Nice To Haves

Bachelor’s degree.
Advanced knowledge of Medicare claims payment rules and reimbursement methodologies.
Clinical coding certification.

Responsibilities

Conduct outreach to client-identified providers by phone, email, and other communication channels to support recruitment and network development.
Coordinate provider onboarding, screening, and enrollment, including explaining processes, assisting with documentation, collaborating with the enrollment team, and resolving enrollment issues.
Support practitioner and provider organization onboarding and retention to maintain effective network participation.
Review and prepare practitioner and provider organization contracts, including in-network, out-of-network, and single-case agreements.
Respond to provider and client inquiries about benefits, procedures, documentation, payments, and other program matters, ensuring timely resolution and follow-up.
Manage customer service escalations, including phone queue and voicemail inquiries, according to established workflows.
Review and respond to provider claims appeals, grievances, and payment disputes; use medical coding and billing knowledge to address pricing and payment concerns and document decisions.
Maintain accurate provider and client records, including network information, provider responses, calls, case updates, requests, and referrals.
Track provider outreach, assess geographic network coverage, and prepare client reports on provider network performance.
Maintain provider policy documentation, communicate updates, and conduct provider training sessions and webinars on program requirements, systems, and tools.
Collaborate with technical teams to support accurate configuration of Medicare billing codes and reimbursement methodologies.
Perform other duties as assigned to support internal and external customers and client program objectives.
Read, understand, and follow corporate policies, including HIPAA Privacy and Security Rules.