Personify Health logo
Personify Health

Because health is personal

Provider Relations Specialist

GeneralGeneralFull TimeRemoteJuniorTeam 1,001-5,000Since 2023H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

90 days ago

Salary

$24 - $29 / hour

Seniority

Junior

High School1 yr expEnglish

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

Related Categories

Related Job Pages

More General Jobs

Candid Health logo

Medical Biller

Candid Health

Easy, automated medical billing.

General90 days ago
ContractRemoteTeam 11-50H1B No Sponsor

• You’ll contact payers for medical claims status, followup denials, or partial payments • You’ll obtain payer requirements for timely adjudication of claims • You’ll file claims with appropriate documentation attached • You’ll pursue, maintain, and communicate medical coverage/guideline changes/updates to our internal team and/or customers • You’ll process all incoming and outgoing correspondence as assigned • You’ll verify, adjust, and update Accounts Receivable (A/R) according to correspondence received from insurance company • You’ll help facilitate communication on error and denial trends • You’ll initiate the review/appeals process on disputed claims • You’ll maintain partnerships with Candid’s Strategy & Operations team regarding customer accounts and claim trends • You’ll maintain HIPAA guidelines

United States
$20 - $27 / hour
Full TimeRemoteTeam 1,001-5,000Since 2004H1B No Sponsor

• The Clinical Specialist provides support to one or more regional sales teams in the areas of market development, procedural coverage, troubleshooting, education and training, customer service and follow-up. • Work with Regional Sales Manager and team members to develop and implement a regional plan aimed at increasing market share and improving quality of service to customers. • Establish a system of communication with Regional Sales Manager and Territory Managers to ensure proper execution of plan and achievement of quarterly objectives. • Develop relationships with hospital personnel to expand contacts in other departments, identify key decision makers and facilitate future sales. • Meet with existing and potential customers to identify their clinical needs, goals and constraints related to patient care, and to demonstrate how Company products can help them achieve their goals. • Educate existing and potential customers on the merits and proper clinical use of Company products by giving presentations and demonstrations, using slides, flow model, brochures and other platforms and formats. • Keep customers abreast of the latest product, therapy, and technology developments, and current items of interest in the industry. • Serve as primary resource for clinical support in the areas of procedural case coverage, basic troubleshooting, and follow-up for Company products.

Montana
$80K - $120K / year
K. Parks Consulting, Inc.- KPC logo

Part-Time Vape Inspector

K. Parks Consulting, Inc.- KPC

// KPC provides worry-free professional services to make your life easier! // Learn 🎓 Innovate 🧞‍♂️Thrive 🌞

General91 days ago
Part TimeRemoteTeam 51-200H1B No Sponsor

• Travel to assigned locations according to the schedule to complete compliance checks. • Perform regular inspections of Vape retailers and complete compliance check inspection forms. • Identify and document relevant facts and findings needed to complete the inspections assigned. • Perform interviews and inspections with key business officials in a professional manner. • Capture and collect high-quality photographs of evidence about the requested information from the inspection form. • Provide accurate, high-quality, and timely reports on all inspections. • Prepare a narrative report revealing potential compliance issues or violations. • Adhere to strict regulations regarding the performance of inspections. • Inspectors may be called upon to testify as witnesses, if and when requested, in administrative hearings and court proceedings related to inspections they conducted.

Alaska + 4 moreAll locations: Alaska | California | Hawaii | Oregon | Washington
$20 / hour
UX Collective logo

Leadership Program Coordinator

UX Collective

The UX Collective is an independent design publication built to elevate unheard design voices all over the world.

General91 days ago
Part TimeRemoteTeam 1-10Since 2004H1B No Sponsor

• Supporting communication and coordination activities within a structured online program environment • Following guided systems and step-by-step processes • Managing communication and follow-up activities • Using simple digital tools to stay organised and consistent • Participating in ongoing professional development and training

New Zealand