Qureos Mentor

Renal Payer Solutions / Champion Health Plans

Overview The Provider Relations Representative is responsible for supporting and maintaining strong relationships with Champion Health Plan&rsquo;s contracted provider network, including primary care physicians, specialists, medical groups, hospitals, and ancillary providers. This role serves as a key liaison, ensuring providers receive timely support, education, and communication.Key Responsibilities:<ul><li>Serve as the primary point of contact for assigned providers and medical groups within an assigned geographic region.</li><li>Support provider onboarding and orientation in partnership with Contracting and internal operational teams.</li><li>Conduct provider and office staff education on health plan policies, tools, workflows, and requirements.</li><li>Perform regular onsite and virtual provider office visits to support relationship management and issue resolution.</li><li>Respond to provider inquiries related to claims, authorizations, referrals, eligibility, and operational processes.</li><li>Coordinate, track, and follow through on provider issues, escalating as appropriate to ensure timely resolution.</li><li>Support provider engagement initiatives related to quality improvement, cost management, access, and clinical programs.</li><li>Assist with preparation and delivery of provider reports, data summaries, and educational materials.</li><li>Communicate network updates, process changes, and regulatory guidance to providers.</li><li>Support network adequacy efforts by identifying provider access, capacity, or coverage gaps in the assigned region.</li><li>Attend joint operations and provider meetings with internal teams and provider partners; document discussion items, action steps, and follow-up activities to ensure timely resolution and accountability.</li><li>Ensure all provider interactions and communications comply with CMS, state, and federal regulations.</li><li>Participate in internal projects and initiatives focused on improving the provider experience.</li></ul>Required Qualifications<ul><li>Bachelor&rsquo;s degree or equivalent combination of education and relevant experience.</li><li>3&ndash;5 years of experience in provider relations, network management, or managed care operations.</li><li>Experience working directly with healthcare providers in a field or network-facing role.</li><li>Strong understanding of managed care and provider office operations.</li><li>Excellent verbal, written, and interpersonal communication skills.</li><li>Strong organizational skills with the ability to manage a geographic territory independently.</li><li>Willingness and ability to travel locally for provider visits.</li></ul>Preferred Qualifications<ul><li>Experience supporting Medicare Advantage (MAPD) provider networks.</li><li>Familiarity with provider onboarding, credentialing, and contracting workflows.</li><li>Knowledge of CMS and Medicare Advantage compliance requirements,</li></ul>Pay: From $70,000.00 per yearBenefits:<ul><li>401(k)</li><li>Dental insurance</li><li>Health insurance</li><li>Vision insurance</li></ul>Work Location: Hybrid remote in Long Beach, CA 90815

Provider Relations Representative

Join Renal Payer Solutions / Champion Health Plans and explore 1   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Renal Payer Solutions / Champion Health Plans

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Provider Relations Representative