Because health is personal
Provider Relations Specialist
Location
United States
Posted
90 days ago
Salary
$24 - $29 / hour
Seniority
Junior
Job Description
Provider Relations Specialist
Personify Health
• Serves as a key relationship and operational liaison between group and the organization’s Care Management/Utilization Management (CM/UM) programs • Supports provider engagement, education, and issue resolution related to referrals, prior authorization/intake processes, and care management programs • Partners with internal UM/CM, Intake, Claims, Network, and Operations teams to ensure providers have clear guidance, timely responses, and consistent service—supporting compliant, high-quality care and a positive provider experience • Build professional, service-oriented relationships with provider offices, facilities, and ancillary organizations through outbound outreach (phone/email/virtual meetings) and timely follow-up • Respond to routine provider inquiries; research and resolve issues within defined turnaround times, using established policies, job aids, and escalation pathways • Provide basic education to providers and office staff on submission requirements, required documentation, timelines, and available CM/UM resources • Route requests to the appropriate internal team (Intake, UM/UR, CM, Claims, Network, Operations) and monitor through closure; communicate status updates to providers as appropriate • Document provider interactions, inquiries, and outcomes accurately in designated systems; maintain complete, professional records • Support provider experience initiatives by identifying service gaps, reporting recurring issues, and recommending updates to job aids or FAQs • Educate providers and office staff on health plan requirements, benefits, prior authorization processes, and care management programs
Job Requirements
- High school diploma or equivalent required; associate’s or bachelor’s degree in healthcare administration, business, public health, or related field preferred
- 1+ years of experience in a healthcare administrative, health plan, provider services, call center, or related role (managed care/TPA experience preferred)
- Proficiency with Microsoft Office (Outlook, Word, Excel) and ability to learn internal platforms and provider portals (e.g., Availity or similar) as required
- Basic computer literacy
- Ability to work on multiple screens, and proficient typing skills
- Excellent verbal and written communication skills
- Ability to speak clearly and convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
- Ability to work independently and utilize resources to problem solve.
- Higher education degree preferred
- Additional proficiencies in Microsoft suite to include SharePoint, and Smartsheet with data analytics
- Knowledge of Availity platform preferred.
Benefits
- Competitive base salary and benefits effective day one
- Comprehensive medical and dental through our own health solutions (yes, we use what we build)
- Paid Time Off—rest and recharge time is non-negotiable
- Mental health support, retirement planning, and financial protection
- Professional development with clear career progression and learning budgets
- Mission-driven culture where diverse perspectives drive real impact on people's health
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