Provider Relations Representative

The Provider Relations Representative evaluates assigned territories and is responsible for recruiting, contracting, and maintaining relationships with physicians, specialists, ancillary providers, and hospitals to support a high-quality, cost-effective provider network. Key Responsibilities: - Identify and target potential providers to establish contractual agreements aligned with network needs. - Analyze and evaluate assigned territories to determine provider recruitment gaps and opportunities. - Recruit and contract physicians, specialists, ancillary providers, and hospitals, ensuring completion of all required documentation, including credentials and site visits. - Conduct site visits for all newly contracted providers to verify compliance with network and regulatory standards. - Negotiate provider contracts and reimbursement rates using utilization and claims data to support financially sound agreements. - Serve as a primary point of contact for provider inquiries related to contracts, network participation, and Health Network One operations. - Collaborate with contracted providers to integrate services into the overall care delivery network. - Maintain effective communication with internal departments and participating providers to support network development and provider referrals. - Support the Credentialing Department by assisting with the collection and maintenance of credentialing and re-credentialing documentation. - Maintain accurate and up-to-date provider files and ensure data integrity in company systems and databases. - Analyze claims and utilization data for newly contracted providers to evaluate performance and contract profitability. - Prepare reports and summaries for presentation to senior management. - Ensure compliance with HIPAA regulations and all company policies and procedures. - Perform additional related duties as assigned. Required Qualifications: - Associate’s degree or equivalent from an accredited two-year college or technical school, or an equivalent combination of education and experience. - Two to three years of experience in a physician office, HMO, managed care organization, or other healthcare environment. Preferred Qualifications: - Experience in provider contracting, network management, or managed care operations. - Familiarity with claims analysis, utilization data, and provider reimbursement structures. Location/Travel: - Remote, may require travel within territory based on network needs