Senior Provider Relations Representative

About This Role

Act as the primary contact for healthcare providers, guiding them through policies and systems to ensure quality care for members. This role involves strong relationship building, education, and both in-office and field engagement to support providers.

Responsibilities

• Serve as the primary contact for assigned providers, offering guidance on claims, authorizations, credentialing, and contracting
• Build strong relationships through regular outreach, meetings, and follow-ups
• Educate providers on Community Care policies, procedures, and product differences
• Coordinate service schedules and ensure consistent phone coverage with your team
• Maintain accurate documentation of provider interactions and action plans
• Support provider onboarding, orientations, and training sessions
• Collaborate with internal teams to resolve provider issues and share feedback
• Travel within the network for face-to-face meetings and community engagement events
• Facilitate meetings with high-needs providers and external stakeholders
• Contribute to provider newsletters, manuals, and educational materials

Requirements

• Strong communication and relationship-building skills
• Ability to manage multiple priorities and work independently
• Willingness to travel based on business needs
• Knowledge of healthcare operations and provider services
• Bachelor’s degree in healthcare, human services, or a related field
• 2 years of experience in a complex organizational environment
• Excellent written and verbal communication skills
• Ability to clearly and consistently explain standards of care and provider agreements
• At least 2 years of experience in a healthcare or managed care setting

Qualifications

• Bachelor’s degree in healthcare, human services, or a related field
• 2+ years of experience in a complex organizational environment and 2+ years of experience in a healthcare or managed care setting

Nice to Have

• Experience in behavioral health services or knowledge of the behavioral health provider system

Skills

* Required skills