Provider Relations Field Representative

Emblem Health • New York, NY

65d • $68,040 - $118,800

About The Position

This is a highly visible, external-facing, field-based role, serving as the primary contact and resource for fee-for-service or value-based providers in the assigned territory, with a focus on government programs such as Medicaid, HARP, Essential, CHP, and Medicare. The position requires working directly with providers to maintain highly satisfying and functioning relationships, engaging with medical office staff, senior leaders, and physicians. The role demands demonstrated subject matter expertise in organizational processes, policies, programs, and provider-facing tools, enabling on-the-spot training and education as needed. This includes onboarding, management of the business relationship and performance, and issue resolution. The goal is to develop relationships that drive growth efforts proactively and increase provider effectiveness through the promotion of organizational quality, risk adjustment (condition coding accuracy), administrative cost effectiveness, and provider/member satisfaction initiatives.

Requirements

• Bachelor's Degree, preferably in a healthcare related field, Public Administration, Business Administration, or Management.
• 4 - 6+ years of relevant, professional work experience (Required)
• 3+ years' experience in healthcare provider relations, sales, contracting or plan or provider operations, or related in Medicare and Medicaid healthcare setting, ideally with physicians, groups, FQHCs (Required)
• Excellent organizational, project management, and relationship management skills (Required)
• Excellent communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience (Required)
• Proficiency with MS Office - Word, Excel, PowerPoint, Teams, Outlook, etc. (Required)
• Understanding of the clinical, economic, and quality components of healthcare (Required)

Nice To Haves

• Live in assigned territory (Preferred)

Responsibilities

• Conduct a minimum of 10 on-site visits per week with designated high-touch providers to assist with provider issues, education materials, communication of EmblemHealth policies and procedures, contractual obligations, and organizational strategic initiatives.
• Educate on processes including claims submissions, recoupments, reconsiderations, authorizations, referrals, medical record management, quality resources, and member resources.
• Meet regularly with assigned providers to conduct training and education, such as required annual trainings, systems training, and electronic solutions (EDI, EFT, EMR, Provider Portal, Tableau reports/dashboards).
• Onboard new providers, including in-person sessions or hosting orientation webinars to educate providers on location and content of all provider-facing materials (Orientation, Provider Manual, Newsletter, Program Updates, etc.).
• Coordinate with various functions within the organization (e.g., claims, operations, enrollment, customer service, medical management, vendor management) to ensure appropriate and prompt handling/resolution of provider issues, inquiries and complaints, while balancing provider needs with organizational priorities.
• Take initiative in preventing and resolving issues between the provider and the Plan whenever possible, and independently troubleshoot problems and drive resolution.
• Initiate, coordinate and participate in problem-solving meetings between the provider and internal stakeholders as necessary.
• Support achievement of organizational strategic goals, including organic growth, performance (quality, coding accuracy, efficiency), and satisfaction.
• Deliver actionable data to providers on value-add opportunities and incentive programs.
• Support network development initiatives, including roll-out of new benefit plans, network sculpting and expansions.
• Ensure regulatory and provider network compliance requirements are met for assigned providers.

Benefits

• Hiring Range: $68,040-$118,800

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees