Provider Relations Representative

Position Description

The Provider Relations Representative is responsible for managing relationships with providers, ensuring they have the necessary information and resources to deliver quality care. This role includes addressing provider inquiries, resolving issues, assisting with credentialing and contracts, and supporting provider onboarding. The ideal candidate will have strong communication and problem-solving skills, along with experience in provider relations, credentialing, and policies.

Role and Responsibilities

• Serve as the primary contact for providers, addressing inquiries and concerns in a timely and professional manner.
• Build and maintain positive relationships with new and existing providers.
• Educate providers on processes, policies, billing, reimbursement, credentialing, and system navigation.
• Investigate and resolve provider issues, coordinating with internal departments as needed.
• Conduct regular provider outreach to maintain engagement and satisfaction.
• Assist with contract negotiations and rate adjustments.
• Stay informed on business guidelines, VA policies, and industry regulations.
• Support the onboarding of new providers by ensuring they have the necessary tools and resources.
• Track and maintain provider credentials, payment documents, and schedules.
• Analyze provider performance metrics and identify areas for improvement.
• Maintain accurate records and documentation in CRM or provider management systems.
• Coordinate with internal departments (e.g., Billing, Customer Service, IT, MRE, and QA) to ensure provider needs are met.

Qualifications and Skills

• Communication, relationship management, and problem-solving skills.
• Ability to work independently and collaboratively in a fast-paced environment.
• Proficient in Microsoft Office Suite and experience with CRM or provider management systems.
• Detail oriented and organized.

Additional Information:

• Hybrid work environment with occasional travel.
• Ability to work on a computer for extended periods.
• Willingness to learn company database systems (e.g., GROW).
• Occasional evening or weekend hours may be required.

Physical and Mental Requirements

Specific mental requirements and abilities essential to the performance of this position include but are not intended to be all-inclusive: reading comprehension and writing capabilities, adaptability, analyzing, assessing, calculating, decision-making, good judgment, social skills, ability to follow instructions, and self-management.

Specific physical requirements and abilities essential to the performance of this position include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus. While performing the duties of this job, the employee is regularly required to stand; sit; use hands to finger, handle, or feel and talk or hear. The employee is frequently required to reach with hands and arm. The employee is occasionally required to walk and stop, kneel, crouch, or lift and/or move up to 20 pounds.

Job Type: Full-time

Address: 5335 Far Hills Ave, Dayton, OH 45429

Benefits:

• 401(k)
• 401(k) matching
• Health, Dental, and Vision Insurance
• Life Insurance
• Paid Time Off
• Professional Development Assistance
• Hybrid Work Schedule