Provider Relations Representative

Duties & Responsibilities:
• Serve as the liaison between providers and the Provider Relations Lead (PRL), addressing network issues and supporting provider relationships.
• Conduct provider training, education, and in-person visits to ensure compliance with policies and procedures.
• Assist the PRL in reporting and training on On-Time Performance (OTP), missed trips, and driver adherence projects to meet Health Plan expectations.
• Assist in recruiting, negotiating, and contracting providers to maintain network adequacy across assigned regions.
• Investigate and resolve provider complaints, claim issues, and service concerns.
• Perform field inspections to monitor provider performance, safety practices, and service quality.
• Support monthly provider touchpoints, quarterly reviews, and overall provider communications.
• Maintain provider records and documentation using PDM and ensure credentials remain current.
• Travel to Facilities and Provider offices as needed.

• High school diploma or equivalent; Spanish proficiency is a plus.
• 2+ years of related experience in provider relations, claims, or customer service; experience with Podiatry/Chiropractic networks is a plus.
• Proficient in Microsoft Word, Excel, PowerPoint, and Outlook.
• Strong communication, customer service, problem-solving, and analytical skills.
• Ability to work independently and collaboratively in the field or office.
• Observational, investigative, and process-oriented with attention to detail.