Provider Relations Representative

CareAbout

9d•Onsite

About The Position

The Provider Relations Representative is responsible for developing and maintaining positive relationships with physicians, providers, and practice managers across our provider network. This role oversees provider performance in incentive and value-based programs, addresses educational needs for providers and office staff, and facilitates solutions for network service issues. Serving as the primary contact, the Provider Relations Representative provides education, technical assistance, and problem-solving support while helping build a strong and engaged provider network.

Requirements

Proven record of driving successful outcomes.
Proficiency in Microsoft Office (Excel, Word, Access, etc.).
Skilled in organizing and leading virtual meetings (Zoom, Teams, WebEx, etc.).
Excellent verbal and written communication skills.
Strong interpersonal and relationship management abilities.
Ability to manage projects in a fast-paced, dynamic environment.
Strong analytical and problem-solving skills with keen attention to detail.
High energy and collaborative mindset.
High school diploma/equivalent required.
Experience in customer service, provider relations, or healthcare-related roles required.

Nice To Haves

Associate or Bachelor’s degree preferred.
Knowledge of provider reimbursement, Medicare reimbursement, coding, HEDIS measures, and care gap reporting preferred.
Familiarity with provider office dynamics and effective communication/education strategies.
Understanding of reimbursement models (FFS, CPT coding, etc.).
Knowledge of MRA & VBC strongly preferred.

Responsibilities

Develop and maintain strong provider relationships, ensuring adherence to contractual requirements.
Educate providers and office staff on health plan operations, policies and procedures, preventative care, quality outcomes, and risk adjustment.
Track, monitor, and report on program performance metrics (e.g., STARs, HEDIS, quality performance measures).
Prepare for and participate in provider meetings, creating agendas and delivering presentations.
Partner with providers and office staff to support membership growth and member retention.
Resolve provider complaints and ensure complaint processes are appropriately managed.
Deliver regular educational updates to providers and staff regarding value-based care (VBC).
Perform additional duties as assigned.