Provider Relations & Onboarding Specialist

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

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.