Provider Relations Specialist

Naples, FL
United States

Experience Required
Degree Required
Employment Type
Work Schedule

Job Description
It’s Time For A Change… Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely about 40% in year-over-year revenue growth in 2018 . Are we recognized? Definitely. We have been named one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, 2017, 2018 and 2019, and One of the “50 Great Places to Work” in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

What You’ll Be Doing:

As a Provider Relations Representative, your initial job duties will include, but are not limited to the following:

The Provider Relations Representative provides training, education and guidance to network providers within the service delivery area. This job is 70% field-based and requires access to personal transportation. The region of travel for this position will include Lee County.

Essential Duties and Responsibilities may include:

  • Cultivate and maintain collaborative relationships with network providers.
  • Ability to contract with PCP’s, specialists, and ancillary providers with no language or rate negotiations.
  • Conduct on-site visits. Tasks include orientation, training, and working with providers and staff to problem solve day-to-day issues and identify barriers.
  • Introduce and familiarize providers on all aspects of the provider manual related to services, benefits and provider requirements; care coordination and authorization protocols; claims filing; and the web portal;
  • Collaborate with network development to identify gaps in the network and access issues.
  • Ensures contract SLA’s are met on frequency of meetings with providers, after hours availability, panel requirements and EMR usage.
  • Resolve network provider inquires timely through email, CRM, joint operating committee meetings and provider visits.
  • Maintain provider data integrity through demographic updates, terminations, etc.
  • Serve as internal liaison with operational departments regarding provider service projects
  • Create reports, projects, and other duties, as appropriate
  • Monitor and trend provider issues documented through workflow, calls, emails, and other avenues
  • Perform other duties as deemed appropriate

The Experience You’ll Need (Required):

  • Bachelor's degree or equivalent years of service
  • 2 years’ experience with provider relations, field experience strongly preferred
  • Working knowledge of Medicaid and/or government managed care products and terminology
  • Familiarity with Region providers and hospitals, preferred
  • Ability to build strong provider relationships
  • Strong organizational, multi-tasking and time-management skills
  • Experience with rapidly adapting to process changes
  • Requires strong competency with Microsoft Office (specifically Microsoft Excel)
  • Proven ability to work independently and as a team member
  • Good communication (written and oral), interpersonal, problem resolution and critical thinking skills

Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.