Provider Relations Representative

General Dynamics Information Technology • USA VA Home Office (VAHOME), VA

1d • $23 - $31 • Remote

About The Position

The Provider Relations Representative is the frontline liaison between the World Trade Center Health Program (WTCHP) and participating healthcare delivery organizations. The role is responsible for provider onboarding, education, issue resolution, relationship management, provider engagement and satisfaction, and coordination of operational support activities. The Representative partners with Provider Data, Credentialing, Contracting, Claims, Finance, Clinical Operations, Communications, and IT to deliver consistent, high‑quality provider experience and ensure operational excellence.

Requirements

• 3+ years in provider relations/provider services or health plan operations (onboarding, education, escalation/issue resolution).
• Strong communication, presentation, facilitation, and relationship‑management skills.
• Proficiency with provider portals and CRM/case management tools; solid Excel/Sheets capability.
• Proven ability to manage multiple priorities, meet SLAs, and produce clear documentation.
• Policy Documentation
• Process Improvements
• Service Level Agreement (SLA)

Nice To Haves

• Bachelor’s degree preferred.
• Experience supporting federal or government‑sponsored healthcare programs.
• Familiarity with claims operations, EDI, credentialing requirements, and provider directory standards.
• Lean/Six Sigma or project management credential (e.g., Green Belt, PMP).
• Relationship building and stakeholder communication; executive presence with provider leaders.
• Operational excellence: organization, prioritization, attention to detail, and SLA discipline.
• Analytical thinking and data‑driven decision‑making; dashboard fluency.
• Conflict resolution, negotiation, and de‑escalation.
• Process improvement and change management.
• Technical fluency: provider portal, CRM, Excel, and virtual meeting tools.

Responsibilities

• Serve as the primary point of contact for assigned providers; conduct regular touchpoints and executive‑level check‑ins/QBRs as needed.
• Track provider sentiment and satisfaction; identify themes and drive action plans with the Provider Network Supervisor.
• Document all interactions, decisions, and follow‑ups in CRM/case management tools with clear, accurate notes.
• Coordinate end‑to‑end onboarding: welcome materials, portal registration, EFT setup, credentialing handoffs, and directory validation.
• Standardize checklists, timelines, and handoffs with Credentialing, Provider Data, and Contracting to ensure accurate participation activation.
• Monitor onboarding milestones and proactively remove blockers; communicate status and next steps to providers.
• Deliver provider training (webinars, welcome packets, job aids) on program policies, billing requirements, and operational procedures.
• Tailor content to provider segments and roles; measure adoption and comprehension via attendance, feedback, and follow‑up assessments.
• Maintain a current library of FAQs, guides, and reference materials aligned to process changes.
• Resolve escalated provider issues related to claims, credentialing, EFT, enrollment, and portal access; triage and route effectively.
• Follow defined escalation pathways; communicate resolution status, root cause, and prevention actions to providers and internal teams.
• Perform root‑cause analysis for recurring issues and propose corrective actions; track remediation to closure.
• Promote portal features and self‑service workflows; assist with registration, user management, navigation, and troubleshooting.
• Increase EFT adoption and ensure accurate banking/EFT data in coordination with Provider Data and Claims; support verification and updates.
• Partner with Provider Data, Credentialing, Contracting, Claims, Finance, Clinical Operations, Communications, and IT to resolve issues and improve processes.
• Represent provider needs in workgroups; drive action items to completion and report measurable outcomes.
• Maintain dashboards/logs for satisfaction, first‑contact resolution, onboarding timeliness, case aging, portal adoption, and SLA compliance.
• Analyze trends to prioritize outreach, training topics, and process enhancements; share insights in huddles and business reviews.
• Contribute to continuous improvement initiatives (templates, scripts, automation) to reduce cycle time and error rates.
• Ensure adherence to organizational policies and applicable regulations; maintain audit‑ready documentation and records.
• Safeguard provider information (privacy/security); support audits and corrective action plans.

Benefits

• Variety of medical plan options, some with Health Savings Accounts
• Dental plan options
• Vision plan
• 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match
• Full flex work weeks where possible
• Variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave
• 15 days of paid leave per calendar year to be used for vacations, personal business, and illness
• 10 paid holidays per year
• Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees
• Short and long-term disability benefits
• Life insurance
• Accidental death and dismemberment insurance
• Personal accident insurance
• Critical illness insurance
• Business travel and accident insurance

What This Job Offers

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