Provider Relations Specialist

🔥 1 minute ago

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Personify Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2023

⚕️ Healthcare Insurance

🧘 Wellness

🤖 Artificial Intelligence

Healthcare Insurance • Wellness • Artificial Intelligence

Personify Health is the first personalized health platform company, designed to empower individuals and organizations to achieve better health outcomes through tailored solutions and services. They offer a comprehensive range of solutions including wellbeing navigation, care management, and health plan administration, catering to employers, health systems, health plans, and brokers. Their goal is to simplify healthcare experiences and enhance engagement, ultimately helping businesses optimize their investment in employee health and wellbeing.

📋 Description

• Serves as a key relationship and operational liaison between group and the organization’s Care Management/Utilization Management (CM/UM) programs • Supports provider engagement, education, and issue resolution related to referrals, prior authorization/intake processes, and care management programs • Partners with internal UM/CM, Intake, Claims, Network, and Operations teams to ensure providers have clear guidance, timely responses, and consistent service—supporting compliant, high-quality care and a positive provider experience • Build professional, service-oriented relationships with provider offices, facilities, and ancillary organizations through outbound outreach (phone/email/virtual meetings) and timely follow-up • Respond to routine provider inquiries; research and resolve issues within defined turnaround times, using established policies, job aids, and escalation pathways • Provide basic education to providers and office staff on submission requirements, required documentation, timelines, and available CM/UM resources • Route requests to the appropriate internal team (Intake, UM/UR, CM, Claims, Network, Operations) and monitor through closure; communicate status updates to providers as appropriate • Document provider interactions, inquiries, and outcomes accurately in designated systems; maintain complete, professional records • Support provider experience initiatives by identifying service gaps, reporting recurring issues, and recommending updates to job aids or FAQs • Educate providers and office staff on health plan requirements, benefits, prior authorization processes, and care management programs

🎯 Requirements

• High school diploma or equivalent required; associate’s or bachelor’s degree in healthcare administration, business, public health, or related field preferred • 1+ years of experience in a healthcare administrative, health plan, provider services, call center, or related role (managed care/TPA experience preferred) • Proficiency with Microsoft Office (Outlook, Word, Excel) and ability to learn internal platforms and provider portals (e.g., Availity or similar) as required • Basic computer literacy • Ability to work on multiple screens, and proficient typing skills • Excellent verbal and written communication skills • Ability to speak clearly and convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others • Ability to work independently and utilize resources to problem solve. • Higher education degree preferred • Additional proficiencies in Microsoft suite to include SharePoint, and Smartsheet with data analytics • Knowledge of Availity platform preferred.

🏖️ Benefits

• Competitive base salary and benefits effective day one • Comprehensive medical and dental through our own health solutions (yes, we use what we build) • Paid Time Off—rest and recharge time is non-negotiable • Mental health support, retirement planning, and financial protection • Professional development with clear career progression and learning budgets • Mission-driven culture where diverse perspectives drive real impact on people's health