Provider Relationship Specialist I

Job Description Summary
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Supports contracted providers by responding to routine inquiries related to eligibility, referrals, claims, credentialing status, and basic operational processes. Uses established workflows and available resources to provide standard information, document interactions, complete routine follow-up, and route issues requiring additional review to the appropriate resource.

Provider Relationship Specialist I performs routine, well-defined work under close supervision while building foundational skills in the provider relationship management function. Decisions reference established checklists and procedures, and impact the accuracy of own work. This job follows defined parameters and standard processes, with work reviewed routinely by more experienced staff. ‎
How will you make an impact & Requirements
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KEY RESPONSIBILITIES

- Respond to routine provider inquiries related to eligibility, referrals, claims, credentialing status, and established operational processes using approved procedures and resources.

- Provide standard information regarding provider processes, tools, portal resources, and required next steps.

- Document provider interactions, case details, actions taken, and required follow-up accurately in CRM and applicable tracking systems.

- Complete routine research and follow-up using established workflows, reference materials, and internal systems.

- Route or escalate provider issues that cannot be resolved through established procedures to the appropriate team or more experienced resource.

- Participate in training and onboarding activities to build foundational knowledge of provider operations, network processes, systems, and service standards.

- Complete assigned work in accordance with established quality, accuracy, productivity, and service expectations.

QUALIFICATIONS

- High school diploma or equivalent required; 0–1 year of customer service, healthcare operations, administrative support, or related experience.

- Basic knowledge of customer service and administrative support practices; healthcare or provider operations experience preferred.

- Ability to follow established procedures, workflows, documentation standards, and escalation protocols accurately and consistently.

- Basic proficiency with computer applications and ability to learn CRM, provider management, and related operational systems.

- Strong verbal and written communication skills with the ability to provide clear and professional information to providers and internal stakeholders.

- Ability to organize assigned work, maintain accurate records, and meet established quality and productivity expectations.

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Compensation Range:
$20.00 to
$30.00
The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.

Originally posted on Himalayas