Description
About the Role:
We are seeking a dynamic Provider Relations Specialist to support the day-to-day management of provider relationships and performance across our contracted provider network. This role serves as a key point of contact for participating providers across multiple lines of business, including Medicare Advantage, Medicaid, Marketplace, and the Medicare Shared Savings Program (MSSP) ACO.
The Provider Relations Specialist is responsible for both field and office-based activities, providing education, operational support, and ongoing engagement to assigned providers and practices. A key focus of this role is partnering with providers to improve HEDIS and quality performance, close care gaps, improve appropriate utilization, manage cost trends, and support overall population health outcomes.
This individual will develop strong, trusted relationships with providers and practice staff and use performance data to identify opportunities for improvement. The role requires a combination of relationship management, problem-solving, and analytical skills, with the ability to translate quality, utilization, and cost data into meaningful and actionable opportunities for providers.
Our Values:
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What You'll Do
- Serve as the primary relationship contact for an assigned portfolio of providers across Medicare Advantage, Medicaid, Marketplace, and MSSP ACO programs.
- Build strong provider relationships through routine visits, education, onboarding, and ongoing support.
- Partner with providers to improve HEDIS performance, close care gaps, enhance quality outcomes, and support population health initiatives.
- Analyze provider quality, utilization, and cost-of-care performance data to identify trends and improvement opportunities.
- Conduct provider performance reviews and develop action plans to drive measurable results.
- Support provider engagement, retention, issue resolution, and network growth initiatives.
- Collaborate with internal teams including Quality, Population Health, Clinical Operations, Credentialing, Contracting, and Analytics to support provider success.
- Monitor provider performance, maintain accurate documentation, and communicate key insights, risks, and opportunities to leadership.
- Promote high-quality, cost-effective care while supporting value-based care objectives across contracted networks.
Qualifications
- Bachelor's degree or equivalent combination of education and relevant experience preferred.
- 2-3 years of experience in Provider Relations, Network Management, Managed Care, Healthcare Operations, or a related healthcare field.
- Experience working with physician practices, medical groups, IPAs, health plans, ACOs, or provider organizations preferred.
- Knowledge of Medicare Advantage, Medicaid, Marketplace, MSSP ACO, value-based care, population health, and managed care programs.
- Familiarity with HEDIS measures, quality improvement, care gap closure, utilization management, and provider performance initiatives.
- Strong analytical skills with the ability to interpret performance data and translate findings into actionable recommendations.
- Excellent relationship-building, customer service, problem-solving, and communication skills.
- Strong organizational skills with the ability to manage multiple providers, priorities, and deadlines.
- Proficiency with Microsoft Office Suite, including Excel, Word, PowerPoint, Outlook, Teams, and SharePoint.
- Ability to travel regularly throughout assigned markets.
- An authentic passion for improving provider performance, patient outcomes, and advancing value-based care.
Environmental Job Requirements and Working Conditions
- This position is a field-based role and requires frequent travel throughout assigned markets and provider territories.
- Regular provider office visits are required to support relationship management, education, and performance improvement activities.
- Must maintain a valid driver's license and reliable transportation.
- Occasional evening, overtime, and weekend work may be required based on business needs and provider engagement activities.
- The target compensation range for this role is $72,000 - $85,000 annually. The range represents our national target range for this position and may vary based on experience, education, skills, internal equity, and business needs.