Provider Relations Representative

Careabout; New York (NY); Remote; USD 53,000 - 80,000; Full time

Job summary

CareAbout Health seeks a Provider Relations Representative to manage and enhance relationships with healthcare providers. This role focuses on provider education, performance tracking, and ensuring compliance with contractual obligations, requiring 2-3 years in a medical utilization role. The selected candidate will collaborate closely with provider staff to foster growth and improve quality outcomes in healthcare delivery.

Benefits

Health insurance

401K with employer contribution

Paid time off and holidays

Company-paid life insurance

Access to voluntary disability insurance

Qualifications

• 2-3 years of medical utilization experience including claims review and Value Based Care.
• Knowledge of provider reimbursement, Medicare reimbursement, and coding preferred.
• Experience in customer service/relations roles within healthcare.

Responsibilities

• Develop and maintain positive relationships with providers, ensuring adherence to contractual requirements.
• Monitor and report key performance metrics like STARs and HEDIS.
• Provide educational support to providers on operational topics.

Skills

Leadership

Communication

Analytical Skills

Attention to Detail

Education

High School Graduate/Equivalent

BA / Associate Degree Preferred

Tools

Microsoft Office

Job description

3 days ago Be among the first 25 applicants

Company Description

CareAbout Health is a managed services organization (MSO) that provides expert advice, resources, tools, and other support to its portfolio of medical groups and healthcare focused companies. CareAbout Health is helping align incentives to create a world where patients, providers, and payers work together in a seamless, coordinated manner toward common goals: higher quality, lower cost, better outcomes.

New York, New York 10036

Company Description

CareAbout Health is a managed services organization (MSO) that provides expert advice, resources, tools, and other support to its portfolio of medical groups and healthcare focused companies. CareAbout Health is helping align incentives to create a world where patients, providers, and payers work together in a seamless, coordinated manner toward common goals: higher quality, lower cost, better outcomes.

Role Title: Provider Relations Representative

FLSA Category: Exempt

Role Location: Remote

Reporting Relationships

This position reports to the Chief Operating Officer.

Role Summary And Responsibilities

The Provider Relations Representative develops & maintains positive relationships with physicians, providers, and practice managers within our participating provider network, including oversight & managing performance in various incentives based and/or value-based programs. Responsible for educational needs of providers and their office staff in any matters concerning provider relationships with MSPB and network service issues. Facilitates the development of a comprehensive provider network and serves as the primary contact, offering education, technical assistance and problem solving as necessary.

Key Responsibilities / Essential Functions

• Develop & maintain positive relationships with providers, ensure provider adherence to contractual requirements, and educate providers and office staff on topics including, but not limited to health plan operations/policies and procedures, preventative & quality outcome metrics & risk adjustment.
• Responsible for understanding, developing, tracking, monitoring, and reporting on key programs performance metrics, such as STARs, HEDIS, and other quality performance measures.
• Prepares for and participates in meetings with providers and provider staff and plans, creates & delivers agendas and/or presentations.
• Work closely with providers & office staff to encourage membership growth & member retention.
• Provide follow-up and intervention relating to provider complaints, thereby ensuring that the complaint process is appropriately handled.
• Provide educational updates monthly or as necessary with providers and office staff on changes within VBC.
• Performs other duties as assigned.
  
  

Skills And Competencies

• Proven record of leading a team with successful outcomes.
• Proficient in Microsoft Office skills (Excel, Word, Access, etc.)
• Able to organize and lead ZOOM, Teams, WebEx, and other virtual meeting environments.
• Ability to effectively communicate in English, both verbally and in writing
• Enjoys working in both individual and team settings.
• Able to execute projects in a fluid and fast paced environment.
• Good communication and relationship skills
• Strong analytical skills
• Attention to detail.
• High level of energy
  
  

Qualifications

• High School Graduate/Equivalent; BA / associate degree preferred.
• 2-3 years of medical utilization experience, including but not limited to reviewing claims, Value Based Care, MRA/HCC understanding, front end operations experience.
• Knowledge of provider reimbursement, Medicare reimbursement, coding and HEDIS Measures and care gap reporting preferred.
• Understanding of provider office dynamics and optimal approaches to communicating and educating providers and provider staff
• Understanding of provider reimbursements and coinciding challenges (FFS, CPT code reimbursement, etc.)
• MRA & VBC knowledge.
• Experience in customer service/relations-like roles
• Healthcare experience.
  
  

Physical Requirements

• Can travel 30%-50% per month, comfortably transition between different work positions as needed.
• Capable of handling objects up to 35 pounds when necessary.
• Will occasionally need to move medical equipment using pushing or pulling motions.
• May involve tasks such as bending, stooping, kneeling, or reaching as required.
• Proficient use of computer keyboards is essential, and phone-related tasks are part of the job requirement.
  
  

The compensation range for this position is: $53K - $80K/yr.

Featured Benefits

• Health, dental, and vision insurance.
• 401K with automatic employer contribution.
• PTO and Paid Holidays.
• Company paid Life Insurance.
• Access to voluntary short and long-term disability insurance.
• Access to additional life insurance.
• Access to a variety of Wellness programs.
  
  

CareAbout Health is committed to providing an environment of mutual respect where equal opportunities are available to all applicants and employees without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, related medical conditions and lactation), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as "protected characteristics").

We are interested in every qualified candidate who is legally able to work in the United States without sponsorship. We cannot offer any visa sponsorship now at this time.

Compensation is based on the level and requirements of the role.

Salary within our ranges may also be determined by your education, experience, knowledge, skills, abilities, and location, as required by the role, as well as internal equity and alignment with market data.

Required

Preferred

Job Industries

• Other

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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