Provider Relation Specialist

Provider Relation Specialist

Immediate need for a talented Provider Relation Specialist. This is a 06 Months Contract opportunity with long-term potential and is located in US (Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:26-24844 Pay Range: $22 - $25/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Serve as the primary point of contact for assigned providers and act as a liaison between providers and the health plan
• Manage provider inquiries and resolve issues related to claims, authorizations, credentialing, eligibility, and provider data
• Investigate provider claims issues and coordinate with the appropriate internal teams for resolution
• Conduct provider outreach through phone calls, email, and other communication channels
• Conduct provider meetings and document discussions, issues, attendees, action items, and resolutions
• Research claims and operational issues and route them to the appropriate department when necessary
• Investigate, resolve, and communicate provider claim issues and changes
• Educate providers on policies and procedures related to referrals, claims submission, provider manuals, websites, EDI, and self-service tools
• Support provider onboarding and conduct welcome calls for newly contracted providers
• Conduct provider orientations and assist with developing and updating orientation materials
• Provide training, education, webinars, and other educational outreach to providers
• Track provider issues, escalations, and resolutions through established systems
• Initiate or request updates to provider-related database information and oversee the completion of applicable changes
• Review claims and authorization trends and collaborate with operational teams to identify root causes and solutions
• Support provider surveys, satisfaction initiatives, and retention activities
• Collaborate with Claims, Operations, Network Management, Credentialing, Contracting, and other internal departments to resolve issues and improve the provider experience
• Manage assigned provider relationships, territory responsibilities, and provider portfolios
• Complete assigned reports, audits, follow-ups, and documentation within established timelines
• Perform other duties as assigned while maintaining compliance with applicable policies and standards

Key Requirements and Technology Experience:

• Must have skills: Dental Office Experience
• Provider Relations Experience
• Microsoft Office
• 3-5 years of relevant professional experience
• Dental office experience
• Provider Relations experience
• Proficiency with Microsoft Office
• Strong organizational and communication skills
• Ability to work effectively as part of a team
• Willingness to learn and adapt to new processes
• Experience in healthcare, managed care, Medicare, or Medicaid
• Knowledge of claims billing and coding
• Experience working directly with healthcare or dental providers
• Experience with provider education, onboarding, or network management

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration. Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.