Provider Relations Specialist

Carisk Partners

12d•$19 - $25•Hybrid

About The Position

The Provider Relations Specialist serves as a key liaison between healthcare providers and the Workers' Compensation Payment Integrity Department. This position is responsible for supporting provider engagement, resolving reimbursement inquiries, facilitating provider education, and assisting with dispute resolution activities. The Specialist works collaboratively with internal teams to ensure accurate reimbursement outcomes while maintaining positive provider relationships and supporting organizational payment integrity objectives. The role requires strong knowledge of workers' compensation reimbursement methodologies, provider billing practices, and payment integrity processes, as well as exceptional communication and problem-solving skills.

Requirements

2 to 5 years of experience in workers' compensation, healthcare reimbursement, provider relations, medical billing, claim operations, payment integrity, or bill review
Experience interacting with healthcare providers and resolving reimbursement-related issues preferred
Strong customer service and relationship management skills
Excellent verbal and written communication abilities
Effective conflict resolution and problem-solving skills
Strong attention to detail and analytical capabilities
Ability to manage multiple priorities and meet deadlines
Ability to communicate complex reimbursement concepts clearly and professionally
Microsoft Office Suite, including Excel, Word, Outlook, and Teams
Claims management, bill review, or reimbursement platforms

Nice To Haves

Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Finance, Nursing, or a related field preferred
Equivalent work experience may be substituted for formal education
Experience with provider databases and reporting systems preferred
Relationship Building
Customer Service Excellence
Conflict Resolution
Communication Skills
Accountability
Regulatory Compliance
Team Collaboration
Attention to Detail

Responsibilities

Serve as a primary point of contact for healthcare providers regarding reimbursement inquiries, billing questions, and payment-related concerns
Develop and maintain productive working relationships with hospitals, physician offices, ambulatory surgery centers, and ancillary providers
Respond to provider inquiries in a timely, professional, and customer-focused manner
Research and resolve provider questions related to bill review determinations, payment calculations, reductions, and reimbursement methodologies
Assist in the resolution of provider disputes, appeals, reconsideration requests, and escalated reimbursement issues
Communicate payment determination rationale to providers in a clear and professional manner
Coordinate with bill review, coding, clinical, legal, and operations teams to facilitate issue resolution
Maintain knowledge of applicable workers' compensation regulations, fee schedules, and reimbursement requirements
Ensure provider communications are consistent with regulatory requirements and organizational policies
Support internal compliance initiatives and audit activities as requested
Document provider interactions, inquiries, and resolutions within designated systems
Maintain accurate records of provider disputes, escalations, and communication activities
Participate in process improvement initiatives designed to enhance provider experience and operational efficiency

Benefits

10 Paid Company Holidays
Paid Time Off
Competitive Medical, Dental, and Vision Insurance
Company Sponsored Life Insurance
Supplemental Life Insurance, Short/Long Term Disability, Employee Assistance Program, Flexible Spending Account, and many other Ancillary Benefits
401(k) Retirement Plan with Company Match
ClassPass Wellness Program
Employee Discount Program
Flexible and Hybrid Schedule Options
Internal Education Programs and Tuition Reimbursement Options
Internal Advancement Opportunities
Company-Wide Diversity and Holiday Celebrations