Field Provider Relations Specialist

EmblemHealth; New York (NY); On-site; USD 68,000 - 119,000; Full time

Job summary

EmblemHealth seeks an external-facing, field-based Provider Relations professional to manage primary relationships with government programs, including Medicaid and Medicare. You will conduct on-site visits, educate providers on policies and processes, onboard new providers, and coordinate with multiple internal teams to resolve issues and drive growth.

The role emphasizes training, data delivery on value-added opportunities, and ensuring quality and satisfaction for providers and members within

Qualifications

• Bachelor’s degree in a healthcare-related field or public administration, business, or management.
• 4–6+ years of relevant professional work experience.
• 3+ years in healthcare provider relations, sales, contracting or plan/provider operations (Medicare/Medicaid).
• Excellent organizational, project management, and relationship skills.
• Excellent verbal, written, and presentation communication with diverse audiences.
• Proficiency with MS Office (Word, Excel, PowerPoint, Teams, Outlook).
• Live in assigned territory (preferred).

Responsibilities

• Conduct on-site visits with high-touch providers to address issues and communicate EmblemHealth policies.
• Educate on claims, recoupments, authorizations, referrals, medical records, and member resources.
• Train providers through annual trainings, systems training, and provider portals/EDIs.
• Onboard new providers with in-person sessions or webinars.
• Coordinate with claims, operations, enrollment, customer service, and management to resolve issues.
• Troubleshoot and proactively resolve provider-plan issues.
• Support growth, quality, coding accuracy, and provider/member satisfaction goals.
• Deliver data on value-add opportunities and incentive programs.
• Support network development and rollout of new benefit plans.
• Ensure regulatory and network compliance for assigned providers.

Skills

Organization

Project management

Relationship management

Communication skills

Healthcare knowledge

Education

Bachelor’s degree in healthcare or related field

Tools

MS Office Suite

Job description

EmblemHealth seeks an external-facing, field-based Provider Relations professional to manage primary relationships with government programs, including Medicaid and Medicare. You will conduct on-site visits, educate providers on policies and processes, onboard new providers, and coordinate with multiple internal teams to resolve issues and drive growth.

The role emphasizes training, data delivery on value-added opportunities, and ensuring quality and satisfaction for providers and members within