Manager, Provider Relations

Jobtailor; New Jersey; On-site; USD 75,000 - 110,000; Full time

Job summary

Jobtailor seeks an experienced Provider Relations Specialist to manage hospital relationships and serve as a main contact for operational issues.

You will analyze provider service trends, support value-based care initiatives, and collaborate with Claims, Credentialing, and Provider Data teams to resolve complex provider concerns.

Qualifications

• 4+ years in healthcare operations, provider relations, or related roles.

Responsibilities

• Manage relationships with assigned hospitals and act as primary contact for provider issues.
• Investigate and resolve provider concerns related to claims, rework, appeals, provider data, credentialing, and reimbursement.
• Analyze provider service trends and operational performance to identify root causes.
• Support provider performance initiatives related to quality, access, and efficiency.
• Educate providers on health plan programs, self-service tools, and processes.
• Prepare provider-facing materials and leadership updates.
• Ensure compliance with contractual and regulatory requirements.

Skills

Healthcare operations

Provider relations

Claims processing

Analytical problem-solving

Communication

Education

Bachelor’s degree or equivalent

Tools

Microsoft Excel

Microsoft PowerPoint

Data analysis tools

Job description

• Manage relationships with assigned hospitals


• Serve as a primary point of contact for provider operational issues, inquiries, and escalations


• Investigate and resolve complex provider concerns related to claims, rework, appeals, provider data, credentialing, and reimbursement issues


• Partner with Claims, Appeals, Operations, Provider Data, Credentialing, Medical Management, and Contracting teams


• Analyze provider service trends, operational performance, and issue root causes


• Support provider performance initiatives related to quality, access, operational efficiency, and member experience


• Educate providers on health plan programs, administrative processes, self-service tools, and operational requirements


• Support value-based care initiatives through provider engagement, education, and operational support


• Assist with network adequacy activities, provider recruitment efforts, and regulatory initiatives


• Research and respond to provider complaints, disputes, executive escalations, and regulatory inquiries


• Monitor provider issues through resolution and communicate status updates to internal and external stakeholders


• Support implementation of network and operational initiatives impacting providers


• Prepare provider-facing materials, business summaries, issue analyses, and leadership updates


• Ensure compliance with contractual requirements, regulatory standards, and company policies


• Support special projects and cross-functional initiatives as assigned

Requirements

• 4+ years of experience in healthcare operations, provider relations, network management, managed care, claims, provider services, or related healthcare experience


• Demonstrated experience working directly with physicians, hospitals, ancillary providers, or healthcare organizations


• Experience researching and resolving complex operational or provider-related issues


• Strong analytical and problem-solving skills


• Understanding of healthcare operations including claims processing, provider enrollment, credentialing, provider data management, and reimbursement fundamentals


• Ability to collaborate effectively across a highly matrixed organization


• Strong verbal, written, and presentation communication skills


• Ability to manage multiple priorities simultaneously and deliver results in a fast-paced environment


• Proficiency with Microsoft Excel, PowerPoint, and data analysis tools


• Bachelor's degree or equivalent combination of education and relevant professional experience

Core Competencies

Demonstrates expertise in healthcare operations, provider relations, and claims processing, with a strong focus on analytical problem-solving and effective communication. Capable of managing provider performance initiatives and ensuring compliance with regulatory standards.

Highest-signal resume keywords

• Healthcare Operations Experience


• Provider Relations Management


• Claims Processing Knowledge


• Analytical Problem-Solving Skills


• Strong Communication Skills

Hard Skills

• Claims Processing


• Provider Enrollment


• Credentialing


• Provider Data Management


• Reimbursement Fundamentals


• Data Analysis


• Operational Performance Analysis


• Issue Resolution


• Network Management


• Value-Based Care Initiatives

Soft Skills

• Collaboration


• Problem-Solving


• Time Management


• Presentation Skills


• Verbal Communication

Industry Keywords

• Healthcare


• Provider Services


• Managed Care


• Network Adequacy


• Regulatory Compliance

Tools & Technologies

• Microsoft Excel


• Microsoft PowerPoint


• Data Analysis Tools