Provider Relations Coordinator Jobs (NOW HIRING)

JOB RESPONSIBILITIES

• Bachelor's degreeandone yearof managed care experience in products or contracts OR3years' direct experience in a managed care environment with one year experience inclaims, pricing,products,regulatory complianceor contracts.
• One year direct experience in a position that demonstrates relationship abilities and sound decision-making.
• Prepare credentialing files for submission to credentialing committees and payer organizations; and maintain accurate provider records in credentialing and provider management systems.
• Ability to meet deadlines and work well under pressure and take initiative to work independently.
• Excellent verbal and written communication skills; strong organizational and planning skills.
• PCproficiencyto include Microsoft Officewith exceptional Excelknowledge; proficiencywith PowerPoint,SalesForce.
• Ability and willingness to travel locally for trainings.

PREFERRED JOB RESPONSIBILITIES

• One year of direct experience in provider relations.
• Knowledge and experience in provider reimbursement methods.
• Advanced proficiencywith Salesforce.
• Experience with Premier Provider Web.

~ KEY FUNCTIONS ~

• Interact with provider organizations to provide information onHCSC billing,claims proceduresand compliance.

• Identifyand coordinate resolution of reoccurring issues and policies between providersandinternal departments(e.g.: PASS, contracting, NOSD,etc.)

• Mayparticipatein provider meetings toidentify, develop, andmonitorpotential areas of improvement that will strengthen the ongoing relationship with the provider.

• Build a workingknowledge of HCSC claims processing and reimbursement methodologies.

• Assistwith providerorientation, training and policy education to provider office staff, billingstaffand referral/precertification areas.Ensure providers are informed when changes occur in network stateplanor HCSC policies and procedures and provide appropriate education/in-service.

• Respond to provider inquiriesin a timely mannerand help in claims resolution and payment problems, engagingwith internal partners including, but not limited toPASS, NOSD,contracting.

• Establishrelationships with providers through correspondence and telephone calls.

• Participate in workgroups toenhance provider experience, includingdevelopimprovements to common internal or provider pain points.

• Represent provider perspectiveand timelineswhen working with Internal departments on the resolutions ofprovider issues(e.g.: Claims, roster updates, pricing,etc.)

• Communicate and interact effectively and professionally with co-workers, management, customers,etc.

• Comply withHIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.

• Maintain complete confidentiality ofcompanybusiness.

• Maintain communication with managementregardingdevelopment within areas of assigned responsibilities and perform special projects asrequiredor requested.

• Responsible formaintainingan up-to-date tracker of provider concerns and pain points.Participate in discussions around resolutions.

• Assistproviders and/or internal teamsto assure HCSC meetsand/or exceedsstandards and guidelines for regulatory compliance including provider directoryreviews, annual trainingtrackingandother compliance related itemsex.Secret Shop, HCAPA, dormancy review).

• Assistwith data inquires and resolutions asrequired(e.g.: CAQH, PPW, NPI Crosswalk, Claims lists,roster requests,etc.

• Maintainaccurateandtimelydocumentation within Salesforce, ensuring all provider interactions, outreach activities, issue resolution, and key relationship management details are consistently recorded and updated to support business operations, reporting, and performance tracking.

• Provide project support as needed, including tracking milestones, managing timelines, coordinating cross-functional activities, and contributing to project documentation and status updates.

• Other duties as assigned by leadership.

NOTE: relocation is NOT offered; sponsorship is NOT available either now or in the future. This role is hybrid/flex and requires in-office visibility three days per week, working from home the other two days.