Provider Relations Specialist (AZ and CO Residents Only)

Places You'll Go Therapy•Denver, CO

8d•$60,000 - $65,000•Remote

About The Position

As a Provider Relations Specialist, you will play a crucial role in establishing and maintaining positive relationships between our organization and healthcare providers. You will be responsible for ensuring effective communication, resolving issues, and fostering collaboration to enhance the overall provider experience. Additional training will be completed for the employee to assist with managing insurance authorizations for initial evaluations, ongoing therapy sessions, and re-authorizations. This role requires a combination of excellent communication skills, attention to detail, a deep understanding of healthcare processes, and the ability to manage relationships with various healthcare professionals. (This position is fully remote)

Requirements

Bachelor's degree in business, Healthcare Administration, or a related field.
2+ years of sales, recruiting, account management, provider relations, business development, customer success, or similar experience.
Proven experience in provider relations, healthcare management, or a similar role.
In-depth knowledge of healthcare industry practices, regulations, and trends.
Exceptional interpersonal and communication skills.
Strong problem-solving and analytical abilities.
Ability to work independently and collaboratively in a team-oriented environment.
Proficient in using Microsoft Office and other relevant software applications.
Experience working toward measurable performance goals or quotas.
Proven ability to build and maintain professional relationships.

Nice To Haves

Familiarity with Medicaid and private insurance authorization processes.
Experience with provider network development and management.
Familiarity with healthcare insurance and reimbursement processes.
Knowledge of healthcare compliance and regulatory requirements.

Responsibilities

Process and Submit Authorizations: Prepare and submit initial and ongoing authorization requests to insurance companies (Department of Developmental Disabilities (DDD), Medicaid, and private payers). Monitor expiration dates and ensure re-authorizations are submitted in a timely manner to prevent gaps in service. Maintain accurate documentation of authorization approvals, denials, and expiration dates. Ensure all authorizations are processed in compliance with HIPAA and internal protocols.
Provider Relationship Management: Build and maintain strong, positive relationships with healthcare providers, including physicians, clinics, and other healthcare entities. Serve as the primary point of contact for providers, addressing inquiries, concerns, and building rapport.
Communication and Education: Communicate effectively with providers to disseminate information about our services, policies, and any changes that may impact their operations. Educate providers on new processes, technologies, and initiatives to ensure seamless collaboration.
Issue Resolution: Investigate and resolve provider-related issues, ensuring prompt and effective solutions. Collaborate with internal departments to address and escalate issues as needed, maintaining a focus on customer satisfaction.
Contract Management: Assist in the negotiation, development, and maintenance of provider contracts. Ensure that providers are compliant with contractual obligations and address any deviations or concerns.
Data Analysis and Reporting: Analyze provider performance data to identify trends, opportunities for improvement, and areas of success. Prepare and present regular reports to management on provider relationship metrics and key performance indicators.
Quality Assurance: Monitor and evaluate the quality of services provided by healthcare providers, collaborating with internal teams to implement improvement plans if necessary.
Training and Support: Provide training and support to providers on our systems, tools, and resources to optimize their experience and improve efficiency.