Provider Relations & Network Strategy Specialist

wvumedicine; United States; Remote; USD 65,000 - 90,000; Full time

Job summary

PHH Peak Health Holdings in the United States is seeking a Provider Relations professional to develop and maintain collaborative relationships with providers—physician groups, hospitals, ancillary clinics, and vendors—across multiple product lines. The role emphasizes data-driven education, high-quality outcomes, and patient and provider satisfaction.

Reporting to the Manager of Provider Relations, the incumbent will be detail oriented, a strong communicator, and capable of travel for offsite

Qualifications

• Bachelor's Degree in business or healthcare related field.
• Master’s Degree in Healthcare Administration or Business Administration
• Certified Medical Coder (CMC) through the American Academy of Professional Coders (AAPC)

Responsibilities

• Upholds the health plan mission of making healthcare more accessible, understandable, and collaborative while interacting with providers and colleagues.
• Educates providers regarding policies and procedures related to credentialing, contracting, authorizations, referrals, claims and/or encounters, grievances and appeals, health education, provider education, population health management, care management, pharmacy management, Electronic Health Records and medical record submissions, Health Information Exchange, data exchange and electronic Data Interface and regulatory updates.
• Builds and maintains strong provider relationships.
• Conducts routine periodic outreach to providers based upon business plan and operational goals to include e-mail, telephone, in-person, and scheduled webinar meetings.
• Ongoing assessment of provider efficiencies when dealing with health plan.
• Conducts initial provider orientations as well as ongoing educational outreach.
• Conducts group training sessions.
• Assists with simple provider contract questions including researching problems and resolving escalated issues.
• Represents health plan at healthcare association functions i.e. HFMA, MGMA, AMA
• Participates in regulatory reporting for provider networks, e.g., WV Department of Insurance, Department of Medicaid/ Health Services and CMS.
• Keep abreast of competitors and regulation in market.
• Supports strategic positioning in geographic areas to develop and maintain provider networks.
• Assist Credentialing Department with any difficult to obtain documents.
• Initiates and maintains effective channels of communication with matrix partners including but not limited to, Claims Operations, Medical Management, Credentialing, Contracting, Legal, Analytics, Compliance, Sales and Marketing and Member and Provider Service, to resolve issues and facilitate team and business priorities/opportunities.

Job description

PHH Peak Health Holdings in the United States is seeking a Provider Relations professional to develop and maintain collaborative relationships with providers—physician groups, hospitals, ancillary clinics, and vendors—across multiple product lines. The role emphasizes data-driven education, high-quality outcomes, and patient and provider satisfaction.

Reporting to the Manager of Provider Relations, the incumbent will be detail oriented, a strong communicator, and capable of travel for offsite