Provider Relations Specialist

Doctors HealthCare Plans, Inc.; Coral Gables (FL); On-site; USD 55,000 - 85,000; Full time

Job summary

Doctors HealthCare Plans, Inc. is seeking a Provider Relations Representative to professionally manage orientations for newly contracted providers, maintain education acknowledgments, and disseminate the Provider Handbook and policies.

The role includes annual site visits, oversight of provider accounts, and ensuring timely communications to maintain quality care standards within CMS guidelines. The successful candidate will have 3–5 years in a Medicare Advantage setting, strong communication

Qualifications

• 3–5 years’ experience with a Medicare Advantage Health Plan
• Excellent communication skills (oral and written)
• Fully bilingual English/Spanish (preferred)
• Knowledge of CMS, AHCA and other regulatory guidelines
• Excellent organizational skills
• Flexible disposition for managing special projects
• Strong customer service skills to resolve complex situations
• Ability to drive organizational initiatives

Responsibilities

• Conduct provider orientations within policy timelines
• Secure signed education acknowledgment forms after orientations
• Maintain originals of acknowledgement forms
• Disseminate Provider Handbook, Bulletins, and policies
• Conduct Annual Site Visits for PCPs and High-Volume Specialists
• Oversee assigned provider accounts and site visit tools
• Ensure timely provider communications and training materials
• Coordinate Medicare Advantage plan benefit presentation dinners as needed
• Participate in Quality Management initiatives and special projects
• Address provider complaints and disputes with VP of Provider Relations

Skills

Communication skills

Bilingual English/Spanish

Education

BS/BA Degree

Job description

Doctors HealthCare Plans, Inc. is seeking a Provider Relations Representative to professionally manage orientations for newly contracted providers, maintain education acknowledgments, and disseminate the Provider Handbook and policies.

The role includes annual site visits, oversight of provider accounts, and ensuring timely communications to maintain quality care standards within CMS guidelines. The successful candidate will have 3–5 years in a Medicare Advantage setting, strong communication