Provider Relations Specialist

Description

The Provider Relations Specialist serves as the primary point of contact between the health plan and its contracted providers. This role is responsible for building and maintaining strong relationships with healthcare providers, ensuring they have the tools and support necessary to deliver high-quality care to members. The ideal candidate will have excellent communication, problem-solving, and organizational skills, with a strong understanding of healthcare operations.

This position reports to the Senior Director of Provider Network as part of Verda Healthcare, Inc.

Responsibilities

The Provider Relations Specialist will play a key role in supporting the Senior Director, Provider Network and Contract Management and Provider Services Team in maintaining positive relationships with healthcare providers and ensuring the smooth operation of provider-related activities within the Verda Healthcare contracted Network.

• Serve as the liaison between the health plan and network providers to address inquiries, resolve issues, and ensure satisfaction.
• Provide education and training to providers on policies, procedures, and operational updates, including claims, authorizations, and compliance requirements.
• Conduct routine provider outreach to strengthen relationships and address any concerns.
• Assist with the onboarding of new providers, ensuring accurate documentation and timely setup within the network.
• Monitor and maintain the accuracy of provider information, including demographic updates and credentialing requirements.
• Communicate policy changes, regulatory updates, and other critical information to providers in a timely manner.
• Investigate and resolve provider concerns, including network access, credentialing, claims issues, and payment discrepancies.
• Escalate complex issues to the appropriate internal teams or leadership as needed.
• Track and document provider interactions to ensure follow-up and resolution.
• Ensure provider compliance with contractual, state, and federal regulatory requirements.
• Support network adequacy initiatives by identifying gaps and assisting with recruitment efforts.
• Work closely with internal teams such as member experience, contracting, claims, quality improvement, and compliance to address provider needs.
• Participate in cross-functional projects aimed at improving provider and member experiences.
• Assist in other projects as needed
  
  

Requirements

Minimum Qualifications

• Bachelor's Degree in Health or Business related field or equivalent experience.
• Minimum of 2 years of experience in provider relations, customer service, or healthcare operations.
• Knowledge of managed care, provider contracting, delegated IPAs, and claims processes is preferred.
  
  

Professional Competencies

• Strong verbal and written communication skills.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook, PowerPoint).
• Ability to manage multiple tasks and prioritize effectively in a fast-paced environment
• Strong organizational and detailed oriented.
• Strong analytic and problem-solving skills.
• Project management skills.
  
  

Verda cares deeply about the future, growth, and well-being of its employees. Join our team today!

Job Type: Full-time

Onsite: 100% onsite

Benefits

• 401(k)
• Paid time off
• Health insurance
• Dental Insurance
• Vision insurance
• Life insurance
  
  

Schedule

• Full-time onsite
• Standard business hours Monday to Friday/weekends as needed
• Occasional travel may be required for meetings and training sessions.
  
  

Ability To Commute/relocate

• Reliably commute or plan to relocate before starting work (Required)
  
  

PHYSICAL DEMANDS

Regularly sit/walk at a workstation in an office or cubicle setting. Must occasionally lift and/or move up to 25-50 pounds.

• Other duties may be assigned in support of departmental goals.