Provider Relations Representative

Provider Relations Representative

We are seeking a detail-oriented Provider Relations Representative I to support provider data management and healthcare operations. This position works closely with contracted provider groups, data validation vendors, and internal departments to ensure provider information is accurate, complete, and maintained according to established standards. This is primarily a computer-based administrative and data-entry position with minimal phone interaction. The ideal candidate will be comfortable working with large amounts of information, managing time-sensitive email requests, researching discrepancies, and shifting between priorities as business needs arise.

Responsibilities

• Maintain accurate provider information by entering, reviewing, updating, and validating provider data according to established procedures.
• Complete daily provider database maintenance, including adding new providers, updating existing information, and processing provider terminations.
• Monitor and respond to time-sensitive emails and requests from provider groups, vendors, and internal departments.
• Research and resolve provider data discrepancies using available systems, records, and internal resources.
• Respond to provider data inquiries from internal teams, members, vendors, providers, and other appropriate contacts.
• Prepare, maintain, and distribute monthly and quarterly provider reports.
• Assist medical providers and administrators with access to online eligibility verification systems, including username and password administration.
• Perform application testing within Facets as requested to help support system functionality.
• Assist with website testing and identify potential data or functionality issues.
• Generate and maintain provider directories as needed.
• Assist with annual provider surveys, network filings, and other provider-related reporting requirements.
• Maintain accurate documentation and ensure provider information meets internal quality and compliance standards.
• Balance multiple administrative requests and projects while prioritizing urgent and time-sensitive items.
• Complete additional administrative projects and responsibilities as assigned.

Qualifications

• Associate degree in Business Administration or a related field preferred.
• Approximately 2 years of related healthcare industry experience, preferably within an HMO or health plan environment.
• Experience with provider relations, provider data, claims, healthcare administration, or healthcare operations is highly desirable.
• Experience with Facets application software is a plus.
• Intermediate computer skills, including experience with email, databases, Microsoft Word, spreadsheets, and other electronic business systems.
• Strong data-entry skills with excellent attention to detail and accuracy.
• Strong written and verbal communication skills.
• Ability to research discrepancies and follow issues through to resolution.
• Comfortable working independently while also collaborating with internal departments and external partners.
• Ability to manage changing priorities, deadlines, and multiple projects simultaneously.

Benefit offerings include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and 401K plan. Our program provides employees the flexibility to choose the type of coverage that meets their individual needs. Available paid leave may include Paid Sick Leave, where required by law; any other paid leave required by Federal, State, or local law; and Holiday pay upon meeting eligibility criteria.