Health Providers Relations & Contracts Specialist

Health Providers Relations & Contracts Specialist Overview The Health Providers Relations & Contracts Specialist acts as a key liaison between the insurance company and healthcare providers, managing provider relationships and supporting contract administration to ensure network efficiency, compliance, and provider satisfaction. This role facilitates communication, resolves provider inquiries, and supports provider onboarding and education to maintain a high performing provider network.

Responsibilities

Serve as the primary point of contact for healthcare providers to address inquiries, resolve issues related to contracts, claims, billing, and network participation.

Support provider onboarding processes, including documentation, credentialing coordination, and network setup.

Provide education and training to providers and their staff on insurance policies, claims submission, authorization procedures, and compliance requirements.

Conduct routine outreach and relationship-building activities, including phone calls and site visits, to maintain positive provider engagement.

Assist in the negotiation and administration of provider contracts, ensuring adherence to terms and regulatory standards.

Monitor provider compliance with contractual obligations and regulatory requirements, escalating issues as needed.

Collaborate with internal teams such as claims, contracting, compliance, quality assurance, and network management to resolve provider-related issues.

Document provider interactions, track inquiries, and ensure timely follow-up and resolution.

Support provider recruitment efforts by identifying network gaps and assisting with outreach activities.

Contribute to the development and maintenance of provider education materials and communications.

Minimum Qualifications and Experience

Bachelor’s degree in Business Administration or related field.

2-3 years of experience in provider relations, contract management, or healthcare insurance.

Good knowledge of healthcare delivery systems, provider reimbursement methodologies, and regulatory environment.

Excellent negotiation, communication, and interpersonal skills.

Proficiency in Microsoft Office and contract management software.

Analytical skills to interpret data and support decision-making.

Ability to work collaboratively across multiple departments and with external providers.

Additional Details

Seniority level : Entry level

Employment type : Full-time

Job function : Health Care Provider, Production, and General Business

Industries : Insurance

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