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Provider Relations Representative Jobs (NOW HIRING)

UHS

Provider Relations Rep - ACO

Amarillo, TX · On-site

ACO Provider Relations Representative is responsible for assisting in the full range of provider relations and service interactions for all lines of business within Prominence Health Plan. Will ...

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How much do provider relations representative jobs pay per hour?

As of Jun 16, 2026, the average hourly pay for provider relations representative 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 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 are Provider Relations Representatives?

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.
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Provider Relations Representative jobs near you
Provider Relations Representative

Provider Relations Representative

American Health Partners

Sioux City, IA

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 2 days ago

Job description

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. 

If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! 

Benefits and Perks include:

  • Affordable Medical/Dental/Vision insurance options
  • Generous paid time-off program and paid holidays for full time staff
  • TeleDoc 24/7/365 access to doctors
  • Optional short- and long-term disability plans
  • Employee Assistance Plan (EAP)
  • 401K retirement accounts
  • Employee Referral Bonus Program

ESSENTIAL FUNCTIONS:  To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation 

• Contracting providers and essential vendors in current service areas to maintain CMS adequacy and providing necessary services in the care of the Plan members

• Insuring providers and essential vendors in current service areas meet the credentialing requirements for their appropriate service lines

• Educating providers on the Health Plan(s) functions and roles in caring for its membership

• Ongoing educational updates as prescribed by CMS and the Health Plan(s) policies

• To conduct the education presentations of the Health Plan(s) providers to insure their understanding and commitment with the Health Plan(s)

• Monitor, maintain and support provider relationships to insure network coverage in all areas

• To work with and be involved in implementation as needed

• Establish a positive work environment that encourages participation in process improvement and commitment to department/company success

• Complete corporate assignments as assigned

Required Skills:

• Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships

• Must be able to accept instructions and work independently in the completions of goals and assignments

• Must have strong negotiation, organization, presentation and time management skills

• Must be able to effectively communicate with all levels of medical staff to explain Health Plan(s) program, benefits and goals

• Must be able to work effectively in a team environment 

• Excellent computer skills, including Microsoft Office Suite

• Must be self-motivated, dependable, team and goal-oriented

Required Work Experience:  

• Experience in the health care field required

• Prior experience in network development / network services is preferred

• Prior experience with acute and post-acute facilities is beneficial

• Prior experience with Medicare Advantage plans is helpful

Licensing/Certification/Education Requirements:  

• Bachelor’s degree 

Other Requirements:

• Must be available to work 8 a.m. until 5 p.m. local time

• Position requires travel to network provider locations.

• Teleworking is an option if criteria are met

EQUAL OPPORTUNITY EMPLOYER

Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.

This employer participates in E-Verify.

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About American Health Partners

Sourced by ZipRecruiter

American Health Partners is a family of six divisions staffed by outstanding employees who care deeply about others. Since our inception more than 45 years ago, we have been committed to bringing the highest quality healthcare available to our communities. That commitment continues to serve us, our patients, our customers and our partners well. Today, our diverse healthcare offerings serve nearly 12,000 individuals annually across multiple states. We operate in both urban and rural communities where people need healthcare close to home. By working closely with hospitals and other providers, we offer cost-effective options that give individuals greater control over their healthcare.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Franklin, TN, US

Year founded

1976

Social media

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