Provider Relations Representative

Community First Health Plans; San Antonio (TX); On-site; USD 50,000 - 70,000; Full time

Job summary

A health care organization in San Antonio is seeking a Provider Relations Representative to serve as a liaison with network participants, manage relationships, and ensure high-quality service. The ideal candidate has at least five years of experience in health care customer service and a preferred bachelor's degree. A valid Texas driver's license and a reliable vehicle are required for this role.

Qualifications

• Minimum of 5 years related experience in health care or managed care.
• Experience as a provider relations or member service representative preferred.
• Valid Texas driver's license required.

Responsibilities

• Act as a liaison between the health plan and network providers.
• Build relationships with providers and offer high-quality service.
• Coordinate with compliance and quality staff on credentialing processes.

Skills

Relationship management

Customer service

Communication

Problem-solving

Education

Bachelor's degree in business or related field

Job description

Responsibilities

Provider Relations Representative works as the primary liaison between Community First Health Plans and network participants (physicians, providers, and administrators) of the health plan provider network. This position will build and nurture positive relationships with health plan network participants by providing the onboarding orientation, and delivering guidance and high-quality service through regular engagement by phone and through scheduled in-person visits to targeted provider offices. This position will also coordinate with Compliance & Quality staff on the re-credentialing process; with Provider Contracting staff for contracting issues or concerns; and will periodically assist the Claims staff with auditing and troubleshooting of provider data to ensure proper claims adjudication. The Provider Relations Representative knows and abides by all organizational and departmental policies, sets personal standards, and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner.

Education/Experience

A minimum of five years of related experience in the health care or managed care field of customer service-related work is required. Bachelor’s degree in business, health care, communications, or other related area is preferred. Recent experience as a provider relations representative, member service representative, or relevant claim experience is highly preferred.

Licensure

Valid Texas driver's license as well as a reliable vehicle is required.