Provider Relations Representative

Overview

Employment Type:

Full time

Shift:

Description:

Provider Relations Representative

Summary:

The Provider Relations Representative serves as the primary liaison between the clinically integrated network (CIN), Saint Alphonsus Health Alliance, and its participating providers. This role is responsible for fostering positive relationships, ensuring provider engagement, and supporting compliance with network standards and value-based care initiatives.

The representative acts as a resource for providers on contractual obligations, operational processes, and performance improvement programs, helping to align provider practices with the CIN’s goals for quality, cost efficiency, and patient experience.

Environment: Hybrid environment. Traditional daytime hours. The ideal candidate will be flexible to meet the needs of the physician practices.

• Serve as the day-to-day contact for participating providers and practice leaders; conduct routine touchpoints and site visits.
• Communicate CIN goals, policies, program updates, and timelines; deliver clear, concise guidance to practice staff and clinicians.
• Develop effective decision-making, communications and interpersonal relations to ensure a positive image of the Saint Alphonsus Health Alliance, and to ensure customer satisfaction, supporting and portraying strong client relations philosophies in all encounters.
• Capture provider feedback and escalate themes to leadership to inform program design and operations.
• Facilitate training (live/virtual); maintain toolkits, FAQs, and quick reference guides.
• Prepare concise dashboards, meeting packets, and status updates for internal leadership and practice stakeholders.
• Adheres to all established contracting guidelines.
• Triage provider inquiries (eligibility/attribution, authorizations, claims trends, directory/roster, referral pathways); resolve or route to the appropriate internal team.
• Monitor payer program updates and operational changes; translate implications for practices and coordinate next steps.
• Responsible for accurately creating and maintaining electronic contract files.
• Assists with mailings, tracking spreadsheets and other related duties, including audits, and tracking and trending analysis as may be assigned.
• Engages providers in building positive, long-term consultative relationships while promoting value-added initiatives/services.
• Resolve claims issues while maintaining positive relationships.
• Successfully completes special projects related to the job as assigned by management.
• Travel across territory to meet with providers.
• Work closely with analytics, quality improvement, care management, contracting, credentialing, marketing/communications, and IT to deliver a seamless provider experience.
• Maintains confidentiality and always protects sensitive data.
• Coordinate end-to-end onboarding: credentialing/roster intake, contract and policy orientation, EHR/portal access, data submission set-up, and directory accuracy.
• Manages the new provider orientation process, including scheduling orientation modules with speakers.
• Manages the off-boarding process when a practice/provider/facility terminates from the network ensuring that all parties have been notified, and the process is followed.

• Education and experience as normally obtained through a bachelor’s degree or eight years of experience in a healthcare setting.
• Experience working with managed care contracts, healthcare billing and provider relations preferred.
• Must possess a demonstrated knowledge of patient accounting functions with attention to billing and follow-up, customer service, denials management, quality assurance, training, payment posting and credentialing.
• Effective critical thinking, problem solving, and decision-making skills. Strong quantitative and analytical abilities to process and display data.
• Ability to handle heavy workloads and short deadlines in a positive manner. Adapts quickly to changing conditions, assimilating new processes into job functions and taking ownership.
• Excellent organizational and relationship building skills. Strong customer service orientation and team approach to issue resolution and program success.…