Provider Relations Specialist in United States at Jobgether

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Provider Relations Specialist in the United States.

This role serves as a key connector between healthcare providers and internal care management and utilization management teams, ensuring smooth communication and efficient operational workflows. You will act as the primary point of contact for provider inquiries related to prior authorizations, referrals, and care management processes, helping to remove friction and improve service quality. The position combines relationship management, issue resolution, and healthcare operations support in a fast-paced, mission-driven environment. You will educate providers on processes and requirements while ensuring timely, accurate responses across multiple systems. By coordinating closely with internal departments, you will help ensure compliance, consistency, and a high-quality provider experience. This is a highly collaborative role where strong communication and problem-solving directly impact care delivery outcomes. It is ideal for someone who enjoys structured healthcare operations work with a strong service focus.

• Serve as the primary liaison between healthcare providers and internal teams, supporting care management and utilization management workflows by responding to inquiries, clarifying processes, and ensuring timely resolution of issues.
• Manage provider communications related to referrals, prior authorizations, intake processes, claims coordination, and care management programs while maintaining accurate documentation across systems.
• Conduct provider outreach via phone, email, virtual meetings, or site visits, building strong professional relationships and ensuring consistent service delivery.
• Route and track provider requests across internal teams (UM, CM, Claims, Network, Operations), ensuring follow-up and closure while maintaining clear status updates.
• Educate providers and office staff on health plan requirements, documentation standards, benefits, and operational procedures to improve accuracy and reduce friction.
• Identify recurring issues and service gaps, escalating trends and contributing recommendations to improve job aids, FAQs, and operational processes.
• Ensure adherence to compliance requirements, including HIPAA and internal privacy standards, while maintaining detailed and accurate records of all interactions.

• High school diploma or equivalent required; associate’s or bachelor’s degree in healthcare administration, public health, business, or related field preferred.
• 1+ year of experience in healthcare administration, provider services, call center operations, managed care, or health plan environments.
• Strong understanding of healthcare workflows such as prior authorization, utilization management, claims coordination, or provider relations.
• Proficiency with Microsoft Office tools (Outlook, Word, Excel) and ability to quickly learn internal platforms and provider portals.
• Excellent written and verbal communication skills, with the ability to explain complex healthcare processes in a clear and professional manner.
• Strong organizational skills with the ability to manage multiple requests, prioritize effectively, and meet response deadlines.
• Problem-solving mindset with the ability to work independently while collaborating across multiple internal teams.
• Familiarity with healthcare platforms (e.g., Availity or similar) is a plus.

• Competitive base salary of approximately $24–$29 per hour, depending on experience and location
• Comprehensive medical, dental, and vision coverage starting on day one
• Paid time off to support rest, recovery, and personal balance
• Mental health support programs and employee assistance resources
• Retirement planning options and financial protection benefits
• Professional development opportunities, learning resources, and career growth pathways
• Mission-driven environment focused on improving health outcomes and access to care
• Additional wellness and employee support programs designed to promote overall wellbeing