• Senior Provider Relations Representative

    Job Locations US-RI-Smithfield
    Req No.
    Provider Network Management
    Regular Full-Time
  • Overview

    This position is responsible for cultivating, maintaining and strengthening relationships with the provider community. In this highly visible field position, the provider relations representative acts as the primary liaison between the organization and its providers including primary care practices, specialists, physician organizations, hospitals, ancillary and long term services and supports providers. Primary responsibilities include establishing positive working relationships with providers, effectively communicating with and educating those providers about the organization and resolving provider inquiries.


    • Lead departmental and inter-departmental provider resolution issues to ensure an adequate and satisfied provider network
    • Lead provider recruitment opportunities
    • Develop and maintain strong professional relationships with providers and their staff while functioning as a liaison to the provider community to research and resolve complex provider issues
    • Assure and maintain provider network adequacy
    • Establish regular contact with and visits to provider sites. Visits may include regular operations meetings, staff education, provider orientations, and other events
    • Orient providers on Neighborhood’s policies related to claims; benefits; clinical programs; referral and authorization; regulatory compliance; billing and payments; complaints and appeals; policies and procedures;
    • Participate in the development of departmental policies, procedures and processes
    • Take ownership of the provider relationship, ensuring all provider needs and concerns are addressed and resolved
    • Identify and execute opportunities for provider training and education
    • Manage and respond to a high volume of provider inquiries while ensuring consistent follow through on resolution of issues
    • Represent organization at provider related events and other initiatives, as necessary
    • Responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents
    • Other duties as assigned



    • Bachelor’s degree in Health Administration, Business Administration, Public Health or a related field or an equivalent amount of education and experience
    • Three (3)+ years’ experience with a managed care organization or a health care related organization (e.g. HMO, Medicaid, Medicare)
    • Three (3)+ years’ direct application of coding, billing and reimbursement mechanisms
    • Three (3)+ years’ experience with facility or professional provider relations
    • Experience with commercial, Medicaid or Medicare reimbursement mechanisms
    • Intermediate to Advanced skills in Microsoft Office (Word, Excel, Outlook)
    • Ability to interact well with individuals on all levels, and maintain a professional image and attitude
    • Ability to manage data and processes in multiple platforms
    • Ability to work cross-organizationally to achieve the goals of the company and department
    • Ability to work independently
    • Demonstrated knowledge of billing practices and reimbursement methodologies
    • Detail oriented, with the ability to organize and ability to manage multiple projects simultaneously
    • Excellent Customer Service Skills
    • Excellent written and strong business communication skills (written and verbal) public relations, presentation and facilitation skills
    • Excellent analytical, problem solving and project management skills
    • Demonstrated knowledge of provider operations as they relate to health plans
    • Demonstrated knowledge of claims operations
    • Demonstrated knowledge of provider reimbursement methodologies and contract terms
    • Ability to train staff, as applicable
    • Ability to travel including reliable transportation, a valid driver’s license and proof of insurance


    • Experience in Cognos
    • Experience in MedInsight
    • Experience in SharePoint
    • Experience with commercial, Medicaid or Medicare reimbursement mechanisms
    • Knowledge of Quality Improvement Processes (e.g. Lean, Six Sigma)

    Organizational Competencies

    • Judgement and decision making
    • Gets results
    • Collaboration and teamwork
    • Business-awareness
    • Customer focus

    Job Specific Competencies

    • Problem Solving/Analysis
    • Planning & Organizing
    • Open Communication
    • Relationship Building & Networking
    • Flexibility & Achieving Change

    Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.


    Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org.


    Neighborhood is an EOE M/F/D/V and an E-Verify Employer


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