Provider Relations Representative

• • Serve as a primary point of contact for assigned providers, building and maintaining positive, professional relationships.
• • Respond to provider questions and help resolve issues related to claims status, eligibility, benefits, authorizations, and plan processes, escalating complex matters as appropriate.
• • Conduct provider visits, orientations, and check-ins, both in person and virtual, to support satisfaction and engagement.
• • Track and document provider interactions, issues, and resolutions in the appropriate systems.
• • Support the onboarding of newly contracted providers and communicate changes that affect providers.
• • Deliver provider education and training on plan policies, processes, the provider portal, and self-service tools.
• • Interpret and clarify UH policies and procedures for providers and their staff.
• • Distribute provider communications and updates, and confirm provider understanding.
• • Analyze and monitoring of Secret Shopper calls.
• • Support the provider survey process and relay provider feedback to the Provider Relations Manager and subcommittees.
• • Support the accuracy of provider information in the Provider Directory and Provider Manual by identifying and reporting needed updates.
• • Help identify network access gaps and potential providers, and refer them to the appropriate team.
• • Support regulatory and contractual requirements relevant to assigned providers, including timely documentation and reporting.
• • Support monitoring and oversight of the provider network by tracking provider concerns, access issues, service trends, and operational barriers, and coordinating follow up to help ensure provider experience, network performance, and compliance with plan requirements.
• • Develop and maintain subject-matter knowledge in the assigned area (Generalist, Oral Health, Behavioral Health, or HRSN).
• • Serve as a resource to colleagues and providers on area-specific benefits, requirements, and workflows.
• • Build and maintain relationships within the assigned provider or community-partner community.
• • Behavioral Health: apply behavioral health confidentiality and integration requirements, including 42 CFR Part 2, in all interactions.
• • Oral Health: apply oral health benefit, access, and basic dental claims knowledge in all interactions.
• • HRSN: support community-based organizations with attention to their capacity, onboarding needs, and the realities of partners that may be new to health plan processes.
• • For lead assignments, provide onboarding and peer training, answer day-to-day operational questions, help direct and prioritize team assignments, and serve as a go-to resource for complex workflows while remaining a non-supervisory individual contributor.
• • Identify problems, develop solutions, and implement chosen courses of action within the scope of the role.
• • Perform work in alignment with the organization's mission, vision, and values, and support its commitment to equity, diversity, and inclusion.
• • Comply with UH internal policies and procedures, the Code of Conduct, the Compliance Plan, and applicable federal, state, and local regulations.
• • Perform other assigned duties as required.

• Working with a variety of personalities, maintaining a consistent and fair communication style.
• Satisfying the needs of a fast-paced and challenging company.

• Bachelor’s degree in related field, or equivalent experience.
• 3 years of provider relations, healthcare administration, health plan operations, or related field.
• Knowledge of health plan operations, Managed Care, Coordinated Care Organizations.
• Advanced proficiency in Microsoft Office tools, capability to learn new software.
• Proficiency in data collection, survey analysis and performance reporting.
• Detail oriented, able to multitask and prioritize multiple competing deadlines.
• No suspension/exclusion/debarment from participation in federal health care programs (eg. Medicare/Medicaid)
• Specialization-specific experience for specialized assignments:
• Oral Health: 3 years’ experience with dental providers or dental benefits.
• Behavioral Health: 3 years’ experience with mental health or substance use disorder providers, and familiarity with 42 CFR Part 2.
• HRSN: experience working with community-based organizations or social-services providers.
• Lead specialization assignments: demonstrated advanced knowledge in the assigned specialization, experience training or onboarding peers, and the ability to provide day-to-day guidance and coordinate work assignments without supervisory authority.

PREFERRED QUALIFICATIONS

• Project management experience.
• Ability to work independently and take the lead on assigned projects.
•  Team players with a collaborative mindset and commitment to health equity and community care.
•  Proficient computer skills, including MS Office suite
• Experience considering the impacts of the work on multiple communities, including communities of color, in technical analysis.
• Experience working on a diverse team
• Experience working with different communication styles
• Bi-lingual translation or translation capabilities a plus

• Salary is dependent on skills, experience, and education
• Generous benefits package including vacation PTO, sick leave, federal holidays, and birthday leave
• Medical, dental, and vision insurance
• 401(k) with company match (fully vested immediately)
• Company-sponsored life insurance and additional benefits
• Fitness reimbursement program
• Tuition reimbursement and more

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