Provider Network Relations & Education Specialist

WVU Medicine; Charleston (WV); On-site; USD 60,000 - 85,000; Full time

Job summary

PHH Peak Health Holdings in West Virginia seeks a Provider Relations professional to develop and maintain collaborative provider relationships across physician, hospital, and vendor networks. You will provide objective data and education to stakeholders, report to the Manager of Provider Management, and contribute to shaping the market's network landscape.

The role emphasizes communication, education on credentialing and contracting, and involvement in regulatory reporting such as WV IDs, CMS,

Qualifications

• Bachelor’s degree in business or healthcare (minimum).
• Master’s degree preferred for advancement.

Responsibilities

• Upholds mission to make healthcare accessible and collaborative with providers.
• Educates providers on credentialing, contracting, authorizations, referrals, claims and encounters.
• Builds and maintains strong provider relationships.
• Conducts outreach to providers via email, phone, in-person, and webinars.
• Assess provider efficiencies in health plan processes.
• Performs provider orientations and ongoing educational outreach.
• Leads group training sessions.
• Assists with simple provider contract questions and issue resolution.
• Represent health plan at industry associations (HFMA, MGMA, AMA).
• Participates in regulatory reporting for provider networks (ins., Medicaid, CMS).
• Keeps abreast of competitors and market regulations.
• Supports strategic positioning to develop provider networks.
• Assists Credentialing with difficult-to-obtain documents.
• Maintains communication with matrix partners to resolve issues.

Skills

Strategic thinking

Attention to detail

Excellent communication

Relationship building

Microsoft Office

Provider contracting knowledge

Regulatory awareness

Team collaboration

Problem solving

Education

Bachelor’s degree in business or healthcare

Master’s degree in Healthcare Administration or MBA

Tools

Microsoft Office

Job description

PHH Peak Health Holdings in West Virginia seeks a Provider Relations professional to develop and maintain collaborative provider relationships across physician, hospital, and vendor networks. You will provide objective data and education to stakeholders, report to the Manager of Provider Management, and contribute to shaping the market's network landscape.

The role emphasizes communication, education on credentialing and contracting, and involvement in regulatory reporting such as WV IDs, CMS,