Provider Relations Representative

Overview
The Provider Relations Representative is responsible for supporting and maintaining strong relationships with Champion Health Plan’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:

• Serve as the primary point of contact for assigned providers and medical groups within an assigned geographic region.
• Support provider onboarding and orientation in partnership with Contracting and internal operational teams.
• Conduct provider and office staff education on health plan policies, tools, workflows, and requirements.
• Perform regular onsite and virtual provider office visits to support relationship management and issue resolution.
• Respond to provider inquiries related to claims, authorizations, referrals, eligibility, and operational processes.
• Coordinate, track, and follow through on provider issues, escalating as appropriate to ensure timely resolution.
• Support provider engagement initiatives related to quality improvement, cost management, access, and clinical programs.
• Assist with preparation and delivery of provider reports, data summaries, and educational materials.
• Communicate network updates, process changes, and regulatory guidance to providers.
• Support network adequacy efforts by identifying provider access, capacity, or coverage gaps in the assigned region.
• 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.
• Ensure all provider interactions and communications comply with CMS, state, and federal regulations.
• Participate in internal projects and initiatives focused on improving the provider experience.

Required Qualifications

• Bachelor’s degree or equivalent combination of education and relevant experience.
• 3–5 years of experience in provider relations, network management, or managed care operations.
• Experience working directly with healthcare providers in a field or network-facing role.
• Strong understanding of managed care and provider office operations.
• Excellent verbal, written, and interpersonal communication skills.
• Strong organizational skills with the ability to manage a geographic territory independently.
• Willingness and ability to travel locally for provider visits.

Preferred Qualifications

• Experience supporting Medicare Advantage (MAPD) provider networks.
• Familiarity with provider onboarding, credentialing, and contracting workflows.
• Knowledge of CMS and Medicare Advantage compliance requirements,

Pay: From $70,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Vision insurance

Work Location: Hybrid remote in Long Beach, CA 90815