Provider Relationship Manager - San Antonio

Harbor Health•San Antonio, TX

About The Position

The Provider Relationship Manager serves as the “boots on the ground” representative of the health plan for all in-network provider groups across the region. This role is responsible for ensuring an exceptional member experience by building strong provider relationships, resolving operational issues, improving network performance, and aligning provider groups with the health plan’s strategic objectives. The Provider Relationship Manager acts as the primary point of contact for in-network practices and works cross-functionally with contracting, claims, credentialing, care management, and member services to proactively remove friction and drive measurable network performance improvements. This is a highly visible, field-based role that blends provider relations, operational problem-solving, and performance management.

Requirements

5+ years experience in:
Provider relations
Network operations
Practice management
Health plan operations
Strong understanding of:
Claims processing
Authorizations
Credentialing
Network adequacy
Value-based reimbursement models
Experience working directly with physician groups and MSOs.
Excellent communication and conflict-resolution skills.
Highly organized with ability to manage multiple provider relationships simultaneously.
Willingness to travel regionally (50–70%).

Nice To Haves

Experience in regional or startup health plans.
Experience supporting CINs or value-based models.
Data literacy (Excel, reporting dashboards, performance tracking).

Responsibilities

Provider Relationship Management
Serve as the primary relationship owner for assigned in-network provider groups
Conduct regular in-person and virtual visits with practices.
Build trust-based partnerships with physicians, practice managers, and administrative leadership.
Represent the health plan in a professional, responsive, and solutions-oriented manner.
Member Experience Optimization
Ensure providers understand plan benefits, referral pathways, authorization requirements, and network structure.
Identify and resolve issues that negatively impact member access, scheduling, billing, or care coordination.
Monitor complaints, grievances, and service trends tied to assigned groups.
Proactively intervene to prevent network friction before it impacts members.
Operational Issue Resolution
Troubleshoot and resolve claims, eligibility, prior authorization, and billing concerns.
Partner with internal teams to escalate and close provider issues quickly.
Track and trend recurring operational problems and recommend system improvements.
Support clean claims performance and administrative simplification.
Network Performance & Accountability
Review provider-level performance metrics (access, quality, cost, utilization).
Support implementation of value-based initiatives and performance programs.
Educate providers on quality measures, documentation, and coding best practices.
Assist with corrective action plans when needed.
Network Growth & Retention
Support onboarding of newly contracted provider groups.
Ensure smooth implementation and readiness before go-live.
Monitor provider satisfaction and mitigate termination risk.
Provide field intelligence on competitive dynamics and provider market trends.
Cross-Functional Collaboration
Partner with: Network Contracting Claims Operations Care Management Utilization Management Member Services Credentialing
Serve as the feedback loop between the provider community and internal leadership.

Benefits

A collaborative and innovative work environment committed to member-centered care.
An organization passionate about improving healthcare delivery in Austin and beyond.
Competitive salary and comprehensive benefits package.
Professional development and opportunities for career growth.
A transparent, supportive, and inclusive culture that values every team member’s contributions.

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