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Provider Relations Representative information

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$14

$29

$44

How much do provider relations representative jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for provider relations representative in Portland, OR is $29.58, according to ZipRecruiter salary data. Most workers in this role earn between $23.70 and $33.41 per hour, depending on experience, location, and employer.

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

To thrive as a Provider Relations Representative, you need a solid understanding of healthcare policies, contract negotiation, and customer service, often supported by a bachelor’s degree in healthcare administration or a related field. Familiarity with claims processing systems, CRM software, and provider databases is typically required. Strong interpersonal, problem-solving, and conflict resolution skills help you build effective relationships with healthcare providers. These skills and qualities are essential for ensuring provider satisfaction, resolving issues efficiently, and maintaining strong network partnerships.

What is a provider relations representative?

Provider Relations Representatives are professionals who serve as the main point of contact between healthcare providers, such as doctors or clinics, and health insurance companies or managed care organizations. They handle inquiries, resolve issues, and ensure that providers understand and comply with policies, procedures, and contractual obligations. Their role is crucial in maintaining positive relationships, addressing concerns, and facilitating smooth communication to improve patient care and provider satisfaction.

What does a provider relations representative do?

A provider relations representative works for a health care agency and is the primary liaison between their company and health care providers, such as medical doctors and dentists. As a provider relations representative, your specific job duties vary, depending on your employer. But your responsibilities may include answering questions from doctor’s offices about benefit verification, entering claims data for processing, and maintaining a good relationship with providers. To become a provider relations representative, you need a high school diploma or equivalent, though many employers prefer candidates with an associate or bachelor’s degree in a health care related field and industry experience.

What is the difference between Provider Relations Representative vs Customer Service Representative?

AspectProvider Relations RepresentativeCustomer Service Representative
CredentialsHigh school diploma or equivalent; healthcare knowledgeHigh school diploma or equivalent; customer service skills
Work EnvironmentHealthcare offices, insurance companiesCall centers, retail, service industries
Employer & IndustryHealth insurance, healthcare providersVarious industries including retail, telecom
Search & Comparison IntentUnderstanding roles in healthcare insuranceCustomer support roles across industries

The Provider Relations Representative focuses on managing relationships with healthcare providers and ensuring compliance with insurance policies, often working within healthcare or insurance companies. In contrast, a Customer Service Representative handles general customer inquiries, support, and issue resolution across various industries. While both roles require strong communication skills, the Provider Relations Representative specializes in healthcare provider interactions, making it a more industry-specific position.

What are some common challenges provider relations representatives face when working with healthcare providers, and how can they be addressed?

Provider Relations Representatives often encounter challenges such as resolving complex contract issues, addressing provider concerns about claims processing, and navigating changing healthcare regulations. Building strong communication skills and maintaining up-to-date knowledge of company policies can help address these challenges effectively. Proactively engaging with providers, listening to their feedback, and collaborating with internal departments are key strategies for fostering positive relationships and ensuring provider satisfaction.
More about Provider Relations Representative jobs
What are the most commonly searched types of Provider Relations Representative jobs in Portland, OR? The most popular types of Provider Relations Representative jobs in Portland, OR are:
What are popular job titles related to Provider Relations Representative jobs in Portland, OR? For Provider Relations Representative jobs in Portland, OR, the most frequently searched job titles are:
What job categories do people searching Provider Relations Representative jobs in Portland, OR look for? The top searched job categories for Provider Relations Representative jobs in Portland, OR are:
Provider Relations Representative jobs near you
Infographic showing various Provider Relations Representative job openings in Portland, OR as of August 2026, with employment types broken down into 84% Full Time, 13% Part Time, and 3% Contract. Highlights an 72% Physical, 1% Hybrid, and 27% Remote job distribution, with an average salary of $61,521 per year, or $29.6 per hour.

Medicaid Provider Relations Rep II

Moda Health

Portland, OR • Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 21 days ago

Moda Health rating

8.5

Company rating: 8.5 out of 10

Based on 24 frontline employees who took The Breakroom Quiz

105th of 303 rated insurance

Job description

Let’s do great things, together!

About Moda
Founded in Oregon in 1955, Moda is proud to be a company of real people committed to quality. Today, like then, we’re focused on building a better future for healthcare. That starts by offering outstanding coverage to our members, compassionate support to our community and comprehensive benefits to our employees. It keeps going by connecting with neighbors to create healthy spaces and places, together. Moda values diversity and inclusion in our workplace. We aim to demonstrate our commitment to diversity through all our business practices and invite applications from candidates that share our commitment to this diversity. Our diverse experiences and perspectives help us become a stronger organization. Let’s be better together.


Position Summary
This is a FT hybrid position based in Portland, Oregon.  This position provides concierge customer service to providers by being the liaison between the Medicaid plans. The Provider Relations Representative is responsible for presenting, promoting, and resolving concerns and issues brought forward by providers and internal staff and develop, improve, and streamline existing provider policies with the goal of removing barriers to providing care. This role will also implement projects and policies that impact providers (includes drafting communications, frequently asked questions, resource guides) to support network needs and promote strong, collaborative relationships. This role will also plan, prepare, and develop training materials for contracted providers and will conduct face-to-face trainings throughout the year. Internally, this role will work closely with our Lead Medicaid Provider Relations Representative for other Medicaid lines of business, multiple departments and is a critical role in supporting daily operations.

Pay Range
$54,668.32 - $68,340.67 ​salary (depending on experience). Actual pay is based on qualifications. Applicants who do not exceed the minimum qualifications will only be eligible for the low end of the pay range.

Please fill out an application on our company page, linked below, to be considered for this position.

https://j.brt.mv/jb.do?reqGK=27775587&refresh=true
 

Benefits:

  • Medical, Dental, Vision, Pharmacy, Life, & Disability
  • 401K- Matching
  • FSA
  • Employee Assistance Program
  • PTO and Company Paid Holidays


Required Skills, Experience & Education:

  1. Three or more years of provider relations experience.
  2. Requires expertise in industry practices, specialized payment methodologies, Value Based Care agreements, Payer/Provider Strategic Partnerships, and all relevant regulations.
  3. College degree in health care, business, analytics, or related field, or equivalent work experience.
  4. Knowledge of Medicaid claims and benefits.
  5. Proficient in identifying and interpreting Oregon Administrative Rules, CCO and provider contracts
  6. Knowledge of provider payment methodologies including capitation, DRG, CAH and other facility and professional pricing.
  7. Ability to analyze and validate provider claims and payment data.
  8. Experience in manual processing of high dollar checks.
  9. Judgement, self-motivation, and the ability to work independently, and as part of a team.        
  10. Is detail oriented and possess strong analytical, and problem-solving skills.
  11. Skilled at delivering trainings and facilitating meetings.
  12. Strong interpersonal communication skills and the ability to develop effective relationship with
  13. network providers, members, and partners.
  14. Proficiency in Microsoft Word, Excel, and PowerPoint.
  15. Ability to work well under pressure with frequent interruptions and shifting priorities.
  16. Must be willing to travel for provider training sessions.
  17. Knowledge of Oregon’s Coordinated Care Organization (CCO) Infrastructure.
  18. Must be able to represent the organizations at outside meetings, conferences, and events in a positive
  19. and professional manner.
  20. Must maintain confidentiality and project a professional business image.

Preferred Skills, Experience & Education:

  1. Knowledge of medical office workflows.
  2. Knowledge of other Moda Health products, plans, and networks.

Primary Functions:

  1. Assist leadership in negotiating Single Case Agreements; review contract terms to ensure they can be operationalized.
  2. Validation of bi-annual Delivery System Network (DSN) Report in partnership with analytics.
  3. Assists with state, federal and other entity related audits.
  4. Contract configuration, implementation, validation, and assessment.
  5. Implement and coordinate new Medicaid provider focused initiatives.
  6. Identify root causes of claim problems and trends and participate in developing solutions. This includes performing research through available systems, policies, and departments, ensuring timely resolution is achieved.
  7. Work in a consultative role with various departments creating effective processes and updates.
  8. Review and update Medicaid provider manuals, policies and procedures as well as desk manuals.
  9. Oversight and management of Medicaid provider webpage content.
  10. Utilize best practice policies and procedures, work guides or tools to provide improved department process workflows. 
  11. Coordinate and participate in targeted provider meetings, including annual Provider Workshops.
  12. Educate providers on Oregon Administrative Rules and contract language ensuring consistent interpretation.
  13. Provide timely responses to all provider inquiries, within two to three business days.
  14. Provides ongoing support to the Medicaid Operations team.
  15. Process provider enrollment applications and meet timelines established by management.
  16. Complete and validate Medicaid encounter data.
  17. Conduct on-site provider visits to create strategic provider partnerships to improve health efficiencies, and foster provider experience.
  18. Attend State and other Medicaid related meetings to learn about new policy and initiative changes that have an impact on operations.
  19. Perform other duties and special projects assigned.

Working Conditions & Contact with Others

  • Position is hybrid, based in Portland Oregon. Extensive close PC and keyboard work.  Occasional require travel to off-site meetings which may include overnight stays.
  • Internally with multiple departments.  Externally with providers, providers staff, office administrators, external partners, Oregon Health Authority staff.


Together, we can be more. We can be better.
 ​​​​​​
Moda Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual orientation, national origin, marital status, disability, veteran status or any other status protected by law. This is applicable to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absences, compensation, and training. 
For more information regarding accommodations, please direct your questions to Kristy Nehler & Danielle Baker via our humanresources@modahealth.com email.

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