Provider Relations Representative

Job not on LinkedIn

🔥 0 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $55k - $60k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New 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

Health Network One

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1999

🏥 Healthcare

⚕️ Healthcare Insurance

🤝 B2B

Healthcare • Healthcare Insurance • B2B

Health Network One is a healthcare network management company that partners with health plans to manage specialty outpatient services (including outpatient therapy, routine and medical eye care, dermatology, and podiatry) under full-risk arrangements. The company operates nationally, covering over 7 million lives and contracting with tens of thousands of providers, and offers delegated services such as utilization management, credentialing, claims and network management. Health Network One emphasizes value‑based solutions, clinical quality, cost reduction for professional and facility spend, and holds NCQA accreditation and HITRUST CSF certification.

📋 Description

• Evaluate assigned territories and identify provider recruitment gaps and opportunities • Recruit, contract, and maintain relationships with physicians, specialists, ancillary providers, and hospitals • Identify and target potential providers to establish contractual agreements aligned with network needs • Complete required contracting documentation, including credentials and site visits • Conduct site visits for newly contracted providers to verify compliance with network and regulatory standards • Negotiate provider contracts and reimbursement rates using utilization and claims data • Serve as a primary contact for provider inquiries regarding contracts, network participation, and Health Network One operations • Collaborate with contracted providers to integrate services into the care delivery network • Communicate with internal departments and participating providers to support network development and provider referrals • Support the Credentialing Department with credentialing and re-credentialing documentation • Maintain accurate provider files and data integrity in company systems and databases • Analyze claims and utilization data to evaluate provider performance and contract profitability • Prepare reports and summaries for senior management • Ensure compliance with HIPAA regulations and company policies and procedures • Perform additional related duties as assigned

🎯 Requirements

• Associate’s degree or equivalent from an accredited two-year college or technical school, or an equivalent combination of education and experience • Two to three years of experience in a physician office, HMO, managed care organization, or other healthcare environment • Experience in provider contracting, network management, or managed care operations • Familiarity with claims analysis, utilization data, and provider reimbursement structures • Ability to travel within assigned territory based on network needs • Knowledge of HIPAA regulations and company policies and procedures