Provider Relations Coordinator

Acentra Health; McLean (VA); On-site; USD 34,000 - 43,000; Full time

Benefits offered by this job

Health plans

Paid time off

Retirement savings

Wellness program

Educational assistance

Corporate discounts

Job summary

Acentra Health is seeking a Provider Relations Coordinator to support provider recruitment, onboarding, and ongoing relations across our programs. You will liaison between providers, clients, and internal teams, handling inquiries, claims concerns, contracts, documentation, and education to promote efficient network participation.

The role emphasizes provider onboarding, contract review, issue resolution, and data accuracy, with a focus on timely responses and adherence to HIPAA rules.

Qualifications

• High school diploma or equivalent (bachelor's degree preferred).
• 2+ years provider-facing experience in healthcare, such as health plan/provider relations, medical billing, claims adjudication, or revenue cycle management, including experience resolving provider inquiries related to claims, pricing, and payments.
• Working knowledge of CPT/HCPCS procedure codes, ICD-10 diagnosis codes, and familiarity with EOBs and 835/837 transaction concepts
• Basic familiarity with Medicare and Medicaid payment rules relevant to provider claims
• Proficiency in Microsoft Office applications, including Outlook, Excel, and Word, with accurate data entry skills

Responsibilities

• Conduct outreach to client-identified providers through phone, email, and other communication channels to support provider recruitment and network development.
• Coordinate provider onboarding, screening, and enrollment activities, including explaining processes, assisting with required documentation, collaborating with the enrollment team, and resolving enrollment-related issues.
• Support practitioner and provider organization onboarding and retention efforts to maintain effective provider network participation.
• Review and prepare practitioner and provider organization contracts, including in-network, out-of-network, and single-case agreements.
• Respond to incoming provider and client inquiries regarding benefits, procedures, documentation, payments, and other program-related matters, ensuring timely resolution and appropriate follow-up.
• Manage customer service escalations, including phone queue and voicemail inquiries, in accordance with established workflows.
• Review and respond to provider claims appeals, grievances, and payment disputes, applying medical coding and billing knowledge to resolve pricing and payment concerns and document decisions.
• Maintain accurate provider and client records, including network information, provider responses, calls, case updates, requests, and referrals, in accordance with established procedures.
• Track provider outreach activities, assess geographic network coverage, and prepare accurate client reports related to provider network performance.
• Maintain provider policy documentation, communicate updates, and conduct provider training sessions and webinars to support understanding of program requirements, systems, and tools.
• Collaborate with technical teams to support accurate configuration of Medicare billing codes and reimbursement methodologies.
• Perform other duties as assigned to support internal and external customers and achieve client program objectives.
• Read, understand, and adhere to all corporate policies, including policies related to HIPAA and its Privacy and Security Rules.

Skills

Verbal communication

Written communication

Organizational skills

Time management

Handling PHI/PHI discretion

Education

High school diploma or equivalent; bachelor's preferred

Tools

Microsoft Excel

Microsoft Outlook

Microsoft Word

Job description

Company Overview

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact.

Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Job Summary and Responsibilities

Acentra Health is looking for a Provider Relations Coordinator to join our growing team.

Job Summary:

The Provider Relations Coordinator supports provider recruitment, enrollment, onboarding, and ongoing provider relations activities to ensure effective participation in Acentra Health programs and systems. This position serves as a liaison between providers, clients, and internal teams, assisting with provider inquiries, claims and payment concerns, contract coordination, and provider education. The role also supports network reporting, accurate documentation, and continuous improvement of provider services to promote operational efficiency and positive provider relationships.

Responsibilities:

• Conduct outreach to client-identified providers through phone, email, and other communication channels to support provider recruitment and network development.

• Coordinate provider onboarding, screening, and enrollment activities, including explaining processes, assisting with required documentation, collaborating with the enrollment team, and resolving enrollment-related issues.

• Support practitioner and provider organization onboarding and retention efforts to maintain effective provider network participation.

• Review and prepare practitioner and provider organization contracts, including in-network, out-of-network, and single-case agreements.

• Respond to incoming provider and client inquiries regarding benefits, procedures, documentation, payments, and other program-related matters, ensuring timely resolution and appropriate follow-up.

• Manage customer service escalations, including phone queue and voicemail inquiries, in accordance with established workflows.

• Review and respond to provider claims appeals, grievances, and payment disputes, applying medical coding and billing knowledge to resolve pricing and payment concerns and document decisions.

• Maintain accurate provider and client records, including network information, provider responses, calls, case updates, requests, and referrals, in accordance with established procedures.

• Track provider outreach activities, assess geographic network coverage, and prepare accurate client reports related to provider network performance.

• Maintain provider policy documentation, communicate updates, and conduct provider training sessions and webinars to support understanding of program requirements, systems, and tools.

• Collaborate with technical teams to support accurate configuration of Medicare billing codes and reimbursement methodologies.

• Perform other duties as assigned to support internal and external customers and achieve client program objectives.

• Read, understand, and adhere to all corporate policies, including policies related to HIPAA and its Privacy and Security Rules.

Qualifications

Required Qualifications

• High school diploma or equivalent (bachelor's degree preferred)

• 2+ years of provider-facing experience in healthcare, such as health plan/provider relations, medical billing, claims adjudication, or revenue cycle management, including experience resolving provider inquiries related to claims, pricing, and payments

• Working knowledge of medical coding and claims fundamentals, including CPT/HCPCS procedure codes, ICD-10 diagnosis codes, and familiarity with EOBs and 835/837 transaction concepts

• Basic familiarity with Medicare and Medicaid payment rules relevant to provider claims

• Proficiency in Microsoft Office applications, including Outlook, Excel, and Word, with accurate data entry skills

Preferred Qualifications

• Advanced knowledge of Medicare claims payment rules and reimbursement methodologies

• Clinical coding certification

• Excellent verbal and written communication, negotiation, and customer service skills, with the ability to clearly explain provider enrollment processes and associated documentation

• Strong organizational and time management skills, with exceptional attention to detail and the ability to manage multiple priorities and meet established deadlines

• Ability to handle confidential business information and protected health information (PHI) with discretion

• Proficiency in reading and interpreting benefits and account information related to customized products

• Strong problem-solving skills, sound judgment, and the ability to make independent decisions

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

Thank You!

We know your time is valuable and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may be of interest. Best of luck in your search!

~ The Acentra Health Talent Acquisition Team

Visit us at https://careers.acentra.com/jobs

EEO AA M/F/Vet/Disability

Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable Federal, State or Local law.

Compensation

The pay range for this position is listed below.

"Based on our compensation philosophy, an applicant's position placement in the pay range will depend on various considerations, such as years of applicable experience and skill level."

Pay Range

USD $24.69 - USD $30.87 /Hr.