Employment Type:

Shift:

Description:

PROVIDER RELATIONS REPRESENTATIVE

SUMMARY:

The Provider Relations Representative serves as the primary liaison between the clinically integrated network (CIN) Saint Alphonsus Health Alliance and its participating providers. This role is responsible for fostering positive relationships ensuring provider engagement and supporting compliance with network standards and value-based care initiatives.

The representative acts as a resource for providers on contractual obligations operational processes and performance improvement programs helping to align provider practices with the CINs goals for quality cost efficiency and patient experience.

ENVIRONMENT: Hybrid environment. Traditional daytime hours. The ideal candidate will be flexible to meet the needs the needs of the physician practices.

REQUIREMENTS:

• Education and experience as normally obtained through a bachelors degree or eight years of experience in a healthcare setting.

• experience working with managed care contracts healthcare billing and provider relations preferred.

• Must possess a demonstrated knowledge of patient accounting functions with attention to billing and follow-up customer service denials management quality assurance training payment posting and credentialing.

• Effective critical thinking problem solving and decision-making skills. Strong quantitative and analytical abilities to process and display data.

• Ability to handle heavy workloads and short deadlines in a positive manner. Adapts quickly to changing conditions assimilating new processes into job functions and taking ownership.

• Excellent organizational and relationship building skills. Strong customer service orientation and team approach to issue resolution and program success. Recognizes the importance of internal and external stakeholders to drive organizational change.

• Comprehensive knowledge of managed care and governmental programs including hospital and physician billing and reimbursement methodologies healthcare benefit designs and claims resolution.

• Proficiency in Microsoft 365 (Outlook Teams Word Excel PowerPoint) and has excellent analytical presentation and interpersonal skills.

• Strong work ethics and desire to succeed with a strong business acumen.

• Ability to work independently and within a team.

WHAT YOU WILL DO:

• Serve as the day-to-day contact for participating providers and practice leaders; conduct routine touchpoints and site visits.

• Communicate CIN goals policies program updates and timelines; deliver clear concise guidance to practice staff and clinicians.

• Develop effective decision-making communications and interpersonal relations to ensure a positive image of the Saint Alphonsus Health Alliance and to ensure customer satisfaction supporting and portraying strong client relations philosophies in all encounters.

• Capture provider feedback and escalate themes to leadership to inform program design and operations.

• Facilitate training (live/virtual); maintain toolkits FAQs and quick reference guides.

• Prepare concise dashboards meeting packets and status updates for internal leadership and practice stakeholders.

• Adheres to all established contracting guidelines.

• Triage provider inquiries (eligibility/attribution authorizations claims trends directory/roster referral pathways); resolve or route to the appropriate internal team.

• Monitor payer program updates and operational changes; translate implications for practices and coordinate next steps.

• Responsible for accurately creating and maintaining electronic contract files.

• Assists with mailings tracking spreadsheets and other related duties including audits and tracking and trending analysis as may be assigned.

• Engages providers in building positive long-term consultative relationships while promoting value-added initiatives/services.

• Resolve claims issues while maintaining positive relationships.

• Successfully completes special projects related to job as assigned by management.

• Travel across territory to meet with providers.

• Work closely with analytics quality improvement care management contracting credentialing marketing/communications and IT to deliver a seamless provider experience.

• Maintains confidentiality and always protects sensitive data.

• Coordinate end-to-end onboarding: credentialing/roster intake contract and policy orientation EHR/portal access data submission set-up and directory accuracy.

• Manages the new provider orientation process including scheduling orientation modules with speakers.

• Manages the off-boarding process when a practice/provider/facility terminates from the network insuring that all parties have been notified and the process is followed.

BENEFITS:
When Saint Alphonsus takes care of you you can take better care of our patients. We offer:

• Medical Dental And Vision Coverage

• Mental Health Resources - Colleagues and their household members each have access to six free counseling sessions and six free coaching appointments per calendar year.

• Meaningful Retirement Benefits - 100% of your deferred contributions dollar-for-dollar up to 3% of pay PLUS 50% on the next 7% of pay. Trinity Healths maximum match is 6.5%.

• Generous PTO plan

Our Commitment

Rooted in our Mission and Core Values we honor the dignity of every person and recognize the unique perspectives experiences and talents each colleague brings. By finding common ground and embracing our differences we grow stronger together and deliver more compassionate person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity national origin disability veteran status or any other status protected by federal state or local law.