Representative, Health Plan Provider Relations (Remote)

1. About Our Client:The organization operates within the managed healthcare sector, focusing on health plan provider relations. It addresses challenges in network development, adequacy, and provider support to ensure compliance with policies and enhance provider collaboration.2. About the Opportunity:The Representative, Health Plan Provider Relations role serves as the main liaison between the health plan and contracted providers. This position is responsible for maintaining network integrity by educating providers, resolving issues, and promoting adherence to policies. The role is critical in fostering provider satisfaction and ensuring effective communication to support health plan initiatives.3. Responsibilities:• Engage with high-volume, high-visibility plan providers to ensure satisfaction and facilitate education on key initiatives.• Serve as the primary contact for non-complex providers including fee-for-service and pay-for-performance providers.• Educate and advocate with external providers to promote compliance and customer service.• Conduct regular provider site visits to assess compliance and service quality.• Provide on-the-spot training and maintain positive provider relationships.• Troubleshoot and resolve provider issues independently.• Coordinate problem-solving meetings between providers and health plan stakeholders.• Deliver training and presentations to providers and their staff.• Monitor and enforce company policies while promoting provider participation in health plan initiatives.• Support training for new and existing provider relations team members as needed.• Travel 60% or more for same-day or overnight visits within the service area.4. Requirements:• Minimum of 2 years experience in customer service, provider services, or claims within managed care or medical office settings.• General understanding of healthcare delivery systems including government-sponsored plans.• Strong organizational skills and attention to detail.• Ability to manage multiple tasks and deadlines.• Effective interpersonal skills for provider and staff interactions.• Experience working in cross-functional, matrixed organizations.• Proficient in verbal and written communication.• Proficiency with Microsoft Office and relevant software.5. Pay Range and Compensation Package:• The pay range and compensation package for this role will be determined based on the candidate’s experience, skills, and other relevant factors.Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.Note:RemoteHunter is not the Employer of Record (EOR) for this role. Our purpose in this opportunity is to connect exceptional candidates with leading employers. We help job seekers worldwide discover roles that match their goals and guide them to complete their full application directly through the hiring company’s career page or ATS.