Provider Relations Specialist

Overview

We are recruiting for a Provider Relations Specialist to join our team at our Corporate site in Fresno, CA. 

Our Provider Relations Specialist manages provider communications, services, intake of issue resolutions, case submissions, case closures, as well as data management to and from our Care Partner (CP) and other providers in the market to build the foundation for a strong connection between UPN and our provider partners. The Provider Relations Specialist is also expected to onboard new practices and CPs, including providing orientations, in-person visit, and education on working with UPN.

Responsibilities

Performance Area 1: Provider Account Management

• Ongoing, professional, and effective communication with all providers in UPN’s network
• Maintain a professional relationship with Care Partner staff
• Provide high level customer service

Performance Area 2: Provider Education and Network Management

• Pro actively research and resolve provider issues including but not limited to claims submission, processing, and payment, contracting details, provider tools, and UM and other protocols
• Ensure accurate ongoing submission of key provider data elements, updates and changes
• Supporting providers through the credentialing/re-credentialing process, including addressing provider questions, ensuring timely completion of applications, and supporting the UPN’s credentialing team
• Provide orientations to contracted providers, ensure alignment and understanding of UPN
• Collaborate with Care Partner Provider Relations staff in the creation and distribution of orientation and educational materials to all levels of personnel within a hospital, ancillary services or physician office setting
• Build provider awareness and engagement with UPN for potential contract opportunities  

Performance Area 3: Cross Functional UPN Support

• Serve as internal UPN provider advocate by communicating key provider pain points and work with key stakeholders to advance support of UPN’s contracted providers
• Collaborate with Marketing, Sales, Provider Data, Credentialing, Operations, and other teams to coordinate cross-functional in-market activities.

Qualifications

EDUCATION:

• High School Diploma or GED required
• Bachelor’s degree in Business, Health Care Administration, Communications or a related field is preferred; equivalent work experience and education will be considered in lieu of a degree

PRIOR EXPERIENCE:

• Three (3) or more years of experience in the healthcare industry navigating relationships around providers and insurance networks, preferred

LICENSE/CERTIFICATION:

• Possess a valid CA driver's license.

SKILLS:

• Must be able to establish rapport and effective working relationships with providers and health center administrators.
• Must have excellent communication skills including negotiation skills; must be persistent and persuasive.
• Must have advanced proficiency in various computer applications and exemplary email communications skills.
• Must be able to prioritize multiple responsibilities and manage a large workload within budget and timelines.
• Must have excellent problem-solving skills and self-motivation.
• Must have the ability to develop alternative solutions to problems.
• Must be able to prepare clear, concise, thorough, meaningful, and grammatically correct written reports, letters, memos and other documents.
• Must be able to independently plan, organize, prioritize, schedule, coordinate, and make decisions related to assigned responsibilities.
• Must have a very strong customer service orientation, positive attitude, and be highly self-motivated, directed, and change oriented.

The pay range for this non-exempt position starts at $30.58 an hour. 

In addition, our comprehensive benefits package for regular status employees includes:

• Medical, Dental, and Vision insurance with low premium cost
• Paid time off and paid holidays
• 401k plan with matching contribution
• Educational Assistance
• Employee discounts and more!

Salary : $31 - $0