Provider Relations Representative

This is a Fully Remote Job

About Our Client:

The organization operates within the healthcare industry, aiming to simplify the healthcare experience and improve access to quality care. It addresses challenges in affordability, responsiveness, and equity within the healthcare system, impacting millions of people and contributing to healthier communities.

About the Opportunity:

The PROVIDER RELATIONS REPRESENTATIVE role focuses on reducing provider contact rates by analyzing repeat call drivers and identifying root causes. This position develops and implements action plans in collaboration with internal business partners and providers, directly contributing to improving operational efficiency and provider service quality.

Responsibilities:

• Analyze claim and prior authorization data to determine call drivers
• Develop and implement action plans to address identified trends
• Drive process improvements across all lines of business to reduce provider contact rates
• Coordinate project and process implementations with business partners
• Create and maintain project documentation including plans, presentations, and reports
• Assess business and provider needs and collaborate on provider service processes
• Serve as a key resource on complex issues affecting Provider Service Operations
• Review and interpret reports and analytics for assigned initiatives
• Collaborate with business partners across various lines of business
• Identify and solve problems using data and facts within area of expertise
• Investigate non-standard requests and issues with some assistance
• Prioritize and organize workload to meet deadlines
• Provide explanations and information to internal and external contacts
• Perform other duties as assigned

Requirements:

• Minimum 2 years knowledge of line of business systems and Provider Service Operations processes
• Minimum 2 years experience or understanding of physician, ancillary, and facility claims including submission, coding, processing, and contracting
• Minimum 1 year customer service experience managing escalated calls and issue resolution
• Minimum 1 year experience educating providers on reimbursement policies and related claims issues
• Minimum 1 year experience researching and communicating reimbursement policies
• Intermediate proficiency with PC-based software and database management systems

Pay Range and Compensation Package:

• Hourly pay ranges from $24.00 to $43.00 based on full-time employment and candidate qualifications
• Pay is influenced by factors including local labor markets, education, experience, and certifications
• Benefits include a comprehensive package, incentive and recognition programs, equity stock purchase, and 401(k) contributions subject to eligibility

Benefits & Perks:

• 401(k)

Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.

Note:

TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.