Provider Field Representative

Jobtailor; Washington (District of Columbia); On-site; USD 60,000 - 90,000; Full time

Job summary

Jobtailor in Washington, DC is seeking a Provider Relations professional to support Medicaid/Medicare provider operations, claims processing, and training initiatives. The role involves delivering workshops, resolving provider issues, and coordinating with internal teams.

You will handle complex claims analysis, offer one-on-one billing support, and travel within the DC Metro area as needed. Strong communication, presentation, and facilitation skills are essential for success.

Qualifications

• Three or more years of working in a provider relations or provider contracting role for a health plan in Medicaid or Medicare.
• Solid understanding of provider operations and key business transactions from a health plan, provider group, or government regulatory perspective.
• Experience working with medical claims processing and claims resolution.
• Strong analytical skills and provider relations skills.
• Excellent communication, presentation, and facilitation skills.
• Some training experience preferred.
• Experience working with business processes.
• Ability to assess clients' business and identify improvement opportunities.
• Willingness and ability to travel in the DC Metro area as needed.

Responsibilities

• Supports the provider community in a variety of areas, including but not limited to virtual and onsite visits, claims follow up and research support, and training development and delivery.
• Performs routine to complex tasks related to provider claiming, program policies, and training.
• Provides training (workshops, seminars, program-specific events) to the provider community and acts as liaison with internal departments and the customer.
• Provides one-on-one billing support, claim research and analysis, and targeted outreach to providers; supports provider association inquiries and events.
• Acts as an escalation point for internal claims staff.
• Liaises with internal departments and the client to ensure that all provider concerns are resolved in a timely and efficient manner.
• Applies knowledge of established policies and procedures to resolve provider issues and ensure compliance.
• Exercises independent judgment within defined practices and procedures to define appropriate actions.

Skills

Provider Relations

Claims Processing

Training Development

Analytical Skills

Communication Skills

Facilitation Skills

Independent Judgment

Job description

• supports the provider community in a variety of areas including but not limited to virtual and onsite visits, claims follow up and research support, as well as virtual and face-to-face training development and delivery


• performs routine to complex tasks that are related to provider claiming, program policies, and training


• provides training (workshops, seminars, program specific group events) to the provider community and acts as liaison with internal departments and the customer


• provides one-on-one billing support, claim research and analysis, and targeted outreach to providers; supports provider association inquiries and events


• acts as an escalation point for internal claims staff


• liaises with internal departments and the client to ensure that all provider concerns are resolved in a timely and efficient manner


• applies knowledge of established policies and procedures to resolve provider issues, and to work with the customer to ensure compliance


• exercises independent judgment within defined practices and procedures to define appropriate actions

Requirements

• Three or more years of working in a provider relations or provider contracting role for a health plan in Medicaid or Medicare


• Solid understanding of provider operations and key business transactions from a health plan, provider group, or government regulatory perspective


• Experience working with medical claims processing and claims resolution


• Strong analytical skills and provider relations skills


• Excellent communication, presentation, and facilitation skills


• Some training experience preferred


• Experience working with business processes


• Ability to assess clients' business and identify improvement opportunities


• Willingness and ability to travel in the DC Metro area as needed

Core Competencies

Demonstrates expertise in provider relations, claims processing, and training development, with a strong focus on compliance and operational efficiency within the healthcare sector. Capable of delivering effective training and support while liaising with internal departments and providers.

Highest-signal resume keywords

• Provider Relations


• Claims Processing


• Training Development


• Analytical Skills


• Communication Skills

ATS Optimization Keywords

Hard Skills

• Claims Resolution


• Provider Contracting


• Business Process Improvement


• Policy Compliance


• Medical Claims Processing

Soft Skills

• Presentation Skills


• Facilitation Skills


• Independent Judgment

Industry Keywords

• Medicaid


• Medicare


• Provider Operations


• Health Plan


• Regulatory Compliance