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Provider Relations Representative Ii Jobs (NOW HIRING)

Blue Shield

$90 - $120/hr

The Provider Relations Representative, Senior will report to the Manager, Provider Services-Relations and be responsible for building provider relationships, supporting contract compliance, and ...

GDIT

Provider Relations Representative

WV · On-site +1

No The Provider Relations Representative is the frontline liaison between the World Trade Center Health Program (WTCHP) and participating healthcare delivery organizations. The role is responsible ...

RXinsider LTD.

$60 - $90/hr

Growing together. As a Provider Relations Representative at Optum, you will act as a direct ... Required Qualifications * 2+ years of health care/managed care experience * 2+ years of provider ...

PrimeMSOSurgicalCenters

Provider Relations

Torrance, CA · On-site

$70K/yr

The Provider Relations Representative primarily handles communication and development for post ... Minimum of two years client-facing experience required * Strong organizational skills * Able to ...

Newdawnaba

MO · On-site

$60K - $90K/yr

New Dawn ABA - Provider Relations & Community Outreach Representative Location: Missouri (Kansas City, St. Louis & Columbia) Job Type: Full-time, field-based role with local travel Pay: $60,000.00 ...

Claremedica Health Partners

NY · On-site

$70 - $90/hr

The Sr. Provider Relations Representative plays a critical role in supporting network integrity, provider performance, operational alignment, referral management initiatives, and overall provider ...

Humana Inc

$65 - $89/hr

## Provider Relations RepresentativeApplylocations: Remote Illinoistime type: Full timeposted on ... Join our growing team as a Provider Engagement Professional 2 reporting to the Manager, Provide ...

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Provider Relations Representative Ii information

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How much do provider relations representative ii jobs pay per hour?

As of Sep 6, 2026, the average hourly pay for provider relations representative ii in the United States is $27.89, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $31.49 per hour, depending on experience, location, and employer.

What is a provider relations representative II?

A Provider Relations Representative II is a healthcare professional who acts as a liaison between healthcare providers, such as doctors or clinics, and insurance companies or managed care organizations. They handle complex issues, ensure providers understand policies and procedures, and help resolve disputes or claims. This role typically involves a higher level of experience and responsibility than entry-level positions, including training new staff and handling escalated cases. Strong communication and problem-solving skills are essential for success in this position.

How does a provider relations representative II typically collaborate with healthcare providers to resolve issues and ensure smooth operations?

A Provider Relations Representative II works closely with healthcare providers to address concerns related to claims processing, contract terms, and network participation. They act as a liaison between providers and the insurance company, facilitating communication and problem-solving. This often involves organizing meetings, conducting training sessions, and following up on outstanding issues to ensure providers have the support they need. Strong relationship-building and conflict resolution skills are essential, as representatives frequently collaborate with internal departments and external partners to maintain positive, productive partnerships.

What are the key skills and qualifications needed to thrive as a provider relations representative II, and why are they important?

To excel as a Provider Relations Representative II, you need strong knowledge of healthcare administration, provider contract management, and a bachelor’s degree in a related field. Familiarity with claims processing systems, CRM software, and healthcare regulations such as HIPAA is typically required. Outstanding interpersonal skills, problem-solving abilities, and effective communication are crucial for building trust with providers and resolving issues efficiently. These skills ensure smooth provider network operations, compliance, and high levels of provider satisfaction.

What is the difference between Provider Relations Representative Ii vs Provider Relations Representative I?

AspectProvider Relations Representative IiProvider Relations Representative I
Required CredentialsHigh school diploma or equivalent; some roles may prefer healthcare or insurance certificationsHigh school diploma or equivalent; entry-level position
Work EnvironmentOffice-based, interacting with healthcare providers and insurance staffOffice-based, supporting provider networks and customer service
Employer & Industry UsageHealthcare insurance companies, managed care organizationsHealthcare insurance companies, managed care organizations
Common Search & ComparisonProvider Relations Representative Ii vs Provider Relations Representative IProvider Relations Representative I

The Provider Relations Representative II typically requires more experience and may handle more complex provider issues compared to the Provider Relations Representative I. Both roles are essential in maintaining provider networks within healthcare insurance companies, but the 'II' level often involves greater responsibilities and expertise.

More about Provider Relations Representative Ii jobs

What job categories do people searching Provider Relations Representative Ii jobs look for?

The top searched job categories for Provider Relations Representative Ii jobs are:

Provider Relations Representative Ii jobs near you
Infographic showing various Provider Relations Representative Ii job openings in the United States as of August 2026, with employment types broken down into 84% Full Time, 14% Part Time, and 2% Contract. Highlights an 77% Physical, 1% Hybrid, and 22% Remote job distribution, with an average salary of $58,011 per year, or $27.9 per hour.

Provider Relations Representative

DOCTORS HEALTHCARE PLANS, INC.

Coral Gables, FL • On-site

Full-time

Posted 23 days ago

Job description

Position Purpose: Exercise the duties and responsibilities delegated to the Provider Relations Representative with the outmost professionalism and dedication
Responsibilities:
  • Responsible for conducting provider orientations of newly contracted providers within the specified time frames as indicated in Policy & Procedure PR - 01.
  • Responsible for securing a signed Notice of Educational In - Service Acknowledgement Form upon completion of each and every provider orientation session conducted.
  • Responsible for maintaining original completed copies of the Notice of Educational In - Service Acknowledgement Forms in the form and format adopted from time to time by the VP of Provider Relations.
  • Responsible for the dissemination of the Provider Handbook / Manual, Provider Bulletins, and applicable Policies and Procedures affecting the Health Plan's Participating Network of Providers on a "as needed" basis.
  • Responsible for conducting the Annual Site Visit for PCPs and High-Volume Specialists within the established time frames as indicated on Policy & Procedure PR - 02.
  • Oversight of the participating provider accounts assigned to him/her by the VP of Provider Relations or her assigned designee
  • Adhere to the delineated Periodic Site Frequency Parameters as may be applicable to established PCPs and High-Volume Specialists
  • Complete the PCP Provider Site Visit Tool to the extent required for each and every Annual and Periodic PCP site visit conducted within their assigned service area
  • Complete the Specialty Provider Site Visit Tool to the extent required for each and every Annual and Periodic Specialty site visit conducted within their assigned service area
  • Conduct Provider After Hours surveys and periodically monitor the accessibility to access to care to ensure that it meets or exceeds such standards as may be established by CMS.
  • Responsible for all communication and training materials distributed to participating providers is up to date.
  • Provide assistance in coordinating the Annual Medicare Advantage Health Plan Benefit presentation dinner meetings to Primary Care Physicians and others as needed.
  • Active participate in Quality Management Program initiatives and QI special projects as may apply.
  • Actively participate in the implementation of special projects logistics reporting pertinent to Provider Corrective Action Plans, Provider Surveys, Provider claim dispute settlements, etc.
  • Effectively address all matters of Provider complaints and disputes as may be presented for resolution to the VP of Provider Relations.
  • Maintain accepted and expected level of proficiency in Federal and State regulatory subject matters as mandated through CMS, AHCA and other applicable agencies governing the operations of Medicare Advantage Plans.

Qualifications:
  • 3 - 5 years' experience with a Medicare Advantage Health Plan or BS/BA Degree
  • Commitment to the Health Plan's vision and mission
  • Excellent communication skills, both in oral and written
  • Fully Bilingual English / Spanish (preferred)
  • Demonstrable knowledge of provider reimbursement methodologies applicable to Medicare Advantage Health Plans and other federal health insurance programs
  • Knowledge of CMS, AHCA and other federal and state current regulatory governing guidelines applicable to HMOs
  • Excellent organizational skills
  • Flexible Disposition to enable management of special projects
  • Excellent Customer Service Skills to enable resolution of complex and varied situations involving multiple internal and external stake holders
  • Ability to drive key organizational / operational initiatives

Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.
No Third Party Agencies or Submissions Will Be Accepted.
Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP
Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.

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