Provider Relations Specialist

Location: Rancho Cordova
Posted on: June 10, 2025

Job Description:

Job Title: Provider Relations Representative

JOB SUMMARY:

Primary job responsibilities involve assisting the Provider Relations Managers with the providers and the provider network. Respond to provider related inquiries received by letter, phone, or internal departments. Assures providers receive exceptional service and response level. Reviews and monitors provider complaints, grievances and escalate issues as necessary to the appropriate Provider Relations Manager. Prepares provider blast fax for newsletters/bulletins. Assist with departmental administrative tasks, as needed. Must be flexible and disciplined enough to multi-task while handling a variety of duties. Attend local Open Enrollment Meetings as appropriate to support clients and providers.

DUTIES AND ACCOUNTABILITIES:

? Initial contact and responder to provider related inquiries received by letter, phone, or internal departments.

? Work closely with Provider Relations Managers to assure providers receive exceptional service and response and escalate issues as necessary.

? Provide continual evaluation of processes and procedures in the department and suggest methods to improve efficiency and service for providers.

? Resolve member incident reports and provider complaints and demonstrate the ability to be resourceful in problem solving.

? Update changes in provider?s practice information such as TIN?s and addresses.

? Assist in recruitment projects, network comparisons and data entry

? Process all outgoing application packets and follow-up letters on a weekly basis.

? Distribution of Provider Bulletins & Newsletters

?Resolve claims issues related to insufficient provider information and make necessary corrections and update databases.

? Administer accurate data entry into multiple provider systems including Access and claims processing systems.

? Assure providers have the appropriate training and resources by participating in provider office education.

? Attend local Open Enrollment Meetings as required to support clients and providers.

? Establish work procedures and processes for Provider Relations that support company and departmental standards and strategic directives.

? Perform other related duties as assigned.

QUALIFICATIONS/REQUIREMENTS:

Education: High school graduate. Two to three years of college or equivalent.

Experience: Requires 7+ years administrative experience. Preferably previous health care experience in a managed health care environment, provider relations or customer service,

including working with members and providers. Excellent computer skills and proficiency with word processing and spreadsheets. Also requires excellent verbal and written communication skills to communicate with providers via phone and written correspondence. Experience and ability to prioritize multiple tasks appropriately. Understanding of vision care insurance is a plus.

We are an equal employment opportunity employer and will consider all qualified candidates without regard to disability or protected veteran status.

Keywords: , Rancho Cordova , Provider Relations Specialist, Healthcare , Rancho Cordova, California