Provider Relations Executive

About the role

The Provider Relations Executive will assist in managing relationships between healthcare providers and the Health Maintenance Organization (HMO). This role involves supporting the onboarding process, coordinating communication between providers and HMO teams, addressing provider inquiries, and helping resolve issues related to claims, billing, or care delivery.

Key responsibilities

• Serve as the primary point of contact for healthcare providers, answering inquiries, providing support, and ensuring they are informed of HMO policies and updates.
• Assist in onboarding new providers, delivering educational materials and training sessions on HMO guidelines and procedures.
• Support providers in understanding and resolving claims and billing issues, acting as liaison with the claims department for timely resolution.
• Monitor provider performance, gather feedback, and prepare performance and satisfaction reports for management review.
• Uphold data protection and confidentiality standards, complying with data security policies and reporting any suspected breaches.
• Execute additional duties assigned by the company, including supporting senior leadership as needed.

Required profile

• Bachelor’s degree in Healthcare Administration, Business, or a related field.
• Minimum of 2 years experience in provider relations, healthcare administration, or customer service within an HMO environment.