Provider Relations Representative

Duties & Responsibilities: Serve as the liaison between providers and the Provider Relations Lead (PRL), addressing network issues and supporting provider relationships.

Conduct provider training, education, and in-person visits to ensure compliance with policies and procedures.

Assist the PRL in reporting and training on On-Time Performance (OTP), missed trips, and driver adherence projects to meet Health Plan expectations.

Assist in recruiting, negotiating, and contracting providers to maintain network adequacy across assigned regions.

Investigate and resolve provider complaints, claim issues, and service concerns.

Perform field inspections to monitor provider performance, safety practices, and service quality.

Support monthly provider touchpoints, quarterly reviews, and overall provider communications.

Maintain provider records and documentation using PDM and ensure credentials remain current.

Travel to Facilities and Provider offices as needed.