Provider Support Specialist

Pride Health; Utah; Hybrid; USD 52,000 - 72,000; Full time

Benefits offered by this job

Healthcare coverage

401(k) retirement savings

Employee assistance program

Job summary

Pride Health is seeking a Provider Support Specialist Contractor to serve as the primary point of contact for healthcare providers, ensuring smooth navigation of claims, benefits, and administrative processes. You will resolve inquiries, document interactions, and collaborate with Claims, Product, and Network teams.

This hybrid role is based out of Lehi, Utah, with on-site expectations two days per week. 2+ years in healthcare operations and strong communication skills are required to deliver

Qualifications

• 2+ years of experience in healthcare operations, provider support, or medical claims.
• Strong understanding of claims adjudication, eligibility, and prior authorization processes.
• Excellent written and verbal communication skills, with the ability to explain complex information clearly.
• Highly organized with strong attention to detail and documentation accuracy.
• Ability to manage multiple priorities in a fast-paced environment.
• Experience working independently in a remote or hybrid setting.
• Familiarity with HIPAA and patient confidentiality requirements.
• Proven problem-solving skills and ability to navigate ambiguity.

Responsibilities

• Serve as a primary liaison between healthcare providers and the company via phone and provider portal messaging.
• Build and maintain strong relationships with provider offices, fostering trust and long-term partnership.
• Investigate and resolve provider inquiries related to claims, eligibility, and benefits.
• Verify and communicate patient eligibility, coverage details, and accumulator balances.
• Document all interactions accurately in internal systems.
• Collaborate cross-functionally to drive timely issue resolution.
• Identify trends in provider issues and elevate systemic problems for root cause analysis.
• Contribute to development of internal tools, workflows, and training materials.
• Educate providers on self-service tools to improve efficiency and reduce friction.
• Meet or exceed SLAs for response and resolution times.

Skills

Communication

Organization

Remote work experience

HIPAA knowledge

Problem-solving

Education

Bachelor's degree in Healthcare Administration

Tools

Availity

Zelis

Assist

Job description

Job Description

Provider Support Specialist Contractor

We are seeking a proactive, detail-oriented Provider Support Specialist Contractor to help scale the Provider Services team. In this role, you will act as a primary point of contact for healthcare providers and their staff, ensuring a seamless experience when navigating claims, benefits, and administrative processes with the company.

You will play a critical role in resolving complex provider inquiries, improving operational workflows, and influencing the overall provider experience through direct feedback and continuous process improvement.

What You'll Do

• Serve as a primary liaison between healthcare providers and the company, delivering timely, accurate, and professional support via phone and provider portal messaging
• Build and maintain strong relationships with provider offices, fostering trust and long-term partnership
• Investigate and resolve complex provider inquiries related to:
  • Claims submission, status, and adjudication
  • Benefit and plan interpretation
  • Member cost-sharing and billing questions
  • Prior authorizations and coordination of benefits
  • Appeals and overpayment recoupment
• Verify and communicate patient eligibility, coverage details, and accumulator balances
• Document all interactions thoroughly and accurately within internal systems
• Collaborate cross-functionally (Claims, Product, Network, etc.) to drive timely and effective issue resolution
• Identify trends in provider issues and elevate systemic problems for root cause analysis and resolution
• Contribute to the development and refinement of internal tools, workflows, and training materials
• Educate providers on self-service tools and best practices to improve efficiency and reduce friction
• Meet or exceed established Service Level Agreements (SLAs) for response and resolution times

What Success Looks Like

• Providers receive clear, accurate, and timely resolutions with minimal follow-up
• High-quality documentation and strong attention to detail across all interactions
• Demonstrated ability to independently resolve complex and ambiguous issues
• Consistent identification of trends and proactive contributions to process improvements
• Positive feedback from providers and internal stakeholders

Basic Qualifications

• 2+ years of experience in healthcare operations, provider support, or medical claims
• Strong understanding of claims adjudication, eligibility, and prior authorization processes
• Excellent written and verbal communication skills, with the ability to explain complex information clearly
• Highly organized with strong attention to detail and documentation accuracy
• Ability to manage multiple priorities in a fast-paced, high-volume environment
• Experience working independently in a remote or hybrid setting
• Familiarity with HIPAA and patient confidentiality requirements
• Proven problem-solving skills and ability to navigate ambiguity

Preferred Qualifications

• Experience in provider-facing or B2B support roles within healthcare
• Familiarity with tools such as Availity, Zelis, or similar clearinghouse platforms
• Experience with contact center systems and case management tools (e.g., Assist)
• Understanding of common claim denial reasons and healthcare payment cycles
• Bachelor's degree in Healthcare Administration or a related field (or equivalent experience)

Tools & Systems

Experience with or ability to quickly learn:

• Provider portals and clearinghouses (e.g., Availity, Zelis)
• CRM or case management systems (e.g., Assist)
• Internal knowledge bases and documentation tools

Work Environment

This is a hybrid role based out of our Lehi office, with an expectation of being onsite at least two weekdays per week.
#PHCNonClinicalZip

Company Description

Pride Health offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, pet insurance and employee discounts with preferred vendors.

Equal Employment Opportunity

Pride Health is an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexua