H-1B Visa Provider Relations Representative Jobs
Provider Relations Representative roles sit at the intersection of healthcare operations and network management, making them strong candidates for H-1B visa specialty occupation classification when the position requires a bachelor's degree in healthcare administration, business, or a related field. Employers in managed care, hospital systems, and insurance networks regularly sponsor H-1B visas for this role.
Find H-1B Visa Provider Relations Representative JobsOverview
Showing 5 of 7+ Provider Relations Representative jobs
See all Provider Relations Representative Jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new Provider Relations Representative roles.
Get Access To All JobsJOB SUMMARY:
The Provider Relations Representative is the external-facing liaison between the health plan and its contracted providers. This role is responsible for onboarding new providers and delivering education on health plan policies, procedures, and clinical quality initiatives, including Star ratings, HEDIS measures, and care gap closures. The Representative will develop relationships with provider offices and ensure they have the tools and knowledge to optimize performance and compliance with health plan initiatives.
KEY RESPONSIBILITIES:
- Conducts initial provider onboarding sessions and ongoing educational sessions with contracted providers according to established standards. Provides ongoing education, develops agendas, organizes informational material, facilitates workshops and participates in meetings for assigned networks. Prepares regular correspondence and special mailings to assigned providers.
- Educates contracted providers on health plan policies, prior authorization process, claims procedures and escalation protocols.
- Delivers focused training on quality improvement initiatives, including Star measures, HEDIS, care gaps and risk adjustment.
- Identify provider performance opportunities and collaborate with quality teams to support targets improvement plans.
- Serve as the primary contact for provider engagement on educational topics, ensuring a high level of customer service.
- Attend provider office visits to build rapport and provide on-site support.
- Track provider engagement and education activities and report on trends and performance metrics.
- Develop and distribute education materials and provider toolkits in collaboration with clinical, quality, pharmacy, and compliance teams.
- Communicate and coordinate with Provider Services Representatives.
- Works in tandem with the Provider Services Representatives to resolve member complaints and grievance issues.
- Participates in special projects and assignments as directed, including the development of new/improved operating procedures.
- Job may contain dimensions that could affect performance of responsibility, which may involve dealing with members who are sensitive and/or emotional.
- Perform other duties as assigned.
QUALIFICATIONS:
- Familiarity with Medicare Advantage, quality improvement programs, Stars ratings and HEDIS.
- Possess strong oral and written communication skills; experience conducting provider trainings.
- Ability to build positive relationships and provide consultative support to provider offices.
- Ability to monitor and assess rapidly changing information.
- Ability to think quickly and respond tactfully to sometimes difficult issues in dealing with providers.
- Successful completion of Health Care Sanctions background check.
- Proficient in Microsoft applications.
- Willingness to travel local for routine provider visits.
- Must have a current driver’s license and insurance verification and reliable transportation.
EDUCATION/EXPERIENCE:
- Bachelor's degree in healthcare administration, public health or related field required OR each year of work experience in a healthcare or managed care setting can be substituted for each year of college not completed.
- Two to three years of industry related experience in managed care, insurance, physician environment or related area.
- Customer Service or sales-related experience preferred.
CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin.
JOB SUMMARY:
The Provider Relations Representative is the external-facing liaison between the health plan and its contracted providers. This role is responsible for onboarding new providers and delivering education on health plan policies, procedures, and clinical quality initiatives, including Star ratings, HEDIS measures, and care gap closures. The Representative will develop relationships with provider offices and ensure they have the tools and knowledge to optimize performance and compliance with health plan initiatives.
KEY RESPONSIBILITIES:
- Conducts initial provider onboarding sessions and ongoing educational sessions with contracted providers according to established standards. Provides ongoing education, develops agendas, organizes informational material, facilitates workshops and participates in meetings for assigned networks. Prepares regular correspondence and special mailings to assigned providers.
- Educates contracted providers on health plan policies, prior authorization process, claims procedures and escalation protocols.
- Delivers focused training on quality improvement initiatives, including Star measures, HEDIS, care gaps and risk adjustment.
- Identify provider performance opportunities and collaborate with quality teams to support targets improvement plans.
- Serve as the primary contact for provider engagement on educational topics, ensuring a high level of customer service.
- Attend provider office visits to build rapport and provide on-site support.
- Track provider engagement and education activities and report on trends and performance metrics.
- Develop and distribute education materials and provider toolkits in collaboration with clinical, quality, pharmacy, and compliance teams.
- Communicate and coordinate with Provider Services Representatives.
- Works in tandem with the Provider Services Representatives to resolve member complaints and grievance issues.
- Participates in special projects and assignments as directed, including the development of new/improved operating procedures.
- Job may contain dimensions that could affect performance of responsibility, which may involve dealing with members who are sensitive and/or emotional.
- Perform other duties as assigned.
QUALIFICATIONS:
- Familiarity with Medicare Advantage, quality improvement programs, Stars ratings and HEDIS.
- Possess strong oral and written communication skills; experience conducting provider trainings.
- Ability to build positive relationships and provide consultative support to provider offices.
- Ability to monitor and assess rapidly changing information.
- Ability to think quickly and respond tactfully to sometimes difficult issues in dealing with providers.
- Successful completion of Health Care Sanctions background check.
- Proficient in Microsoft applications.
- Willingness to travel local for routine provider visits.
- Must have a current driver’s license and insurance verification and reliable transportation.
EDUCATION/EXPERIENCE:
- Bachelor's degree in healthcare administration, public health or related field required OR each year of work experience in a healthcare or managed care setting can be substituted for each year of college not completed.
- Two to three years of industry related experience in managed care, insurance, physician environment or related area.
- Customer Service or sales-related experience preferred.
CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin.
See all H-1B Visa Provider Relations Representative Jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new H-1B Visa Provider Relations Representative Jobs.
Get Access To All JobsTips for Finding H-1B Visa Sponsorship in Provider Relations Representative
Confirm your role meets specialty occupation
Pull the O*NET profile for Provider Relations Representative to document the degree requirements tied to the occupation. USCIS requires your specific position to demand at least a bachelor's degree in a directly related field, so generic job duties won't hold up without that documentation.
Target managed care organizations over staffing firms
Health plans, regional HMOs, and hospital network management divisions file LCAs directly as cap-subject employers. Staffing agency placements add H-1B dependency complexity, which tightens prevailing wage obligations and can slow your petition timeline significantly.
Look up prevailing wages before negotiating your offer
Use the OFLC Wage Search to check the Level I through Level IV wage tiers for your metro area before your offer letter arrives. Employers must pay at least the prevailing wage on your certified LCA, so knowing the floor helps you evaluate whether an offer is compliant.
Filter for verified H-1B sponsors on Migrate Mate
Search Provider Relations Representative roles on Migrate Mate to see employers with confirmed H-1B LCA filing history in healthcare network management. That history signals both sponsorship willingness and familiarity with the DOL certification process for your occupation.
Clarify H-1B transfer timing before your 60-day window closes
If you're leaving an H-1B job, a new employer can file a transfer petition and you can start working upon receipt, but only if you've maintained valid status. Don't wait until your last day to confirm your prospective employer is ready to file.
Request employer E-Verify enrollment confirmation early
STEM OPT employers must be E-Verify enrolled, and many healthcare networks already are, but verify it before you accept an offer if you're bridging from OPT. An employer that isn't enrolled can't legally employ you on STEM OPT while your H-1B petition is pending.
H-1B Visa Provider Relations Representative: Frequently Asked Questions
Does a Provider Relations Representative role qualify as a specialty occupation for H-1B purposes?
It can qualify, but the employer must demonstrate that the specific position requires at least a bachelor's degree in a directly related field, such as healthcare administration, business administration, or a clinical discipline. Roles at larger health plans and managed care organizations tend to have clearer degree requirements tied to the job duties, which strengthens the specialty occupation argument. Generic or entry-level coordinator titles with no degree requirement in the job posting are harder to support.
Which types of employers sponsor H-1B visas for this role?
Managed care organizations, regional health plans, hospital networks, and large physician management groups are the most active sponsors for Provider Relations Representative positions. These employers deal with credentialing, contract negotiation, and network compliance at scale, which creates sustained demand for the role. You can browse employers with verified H-1B LCA filing history for this occupation on Migrate Mate before targeting your applications.
How does the H-1B prevailing wage apply to Provider Relations Representative positions?
Your employer must certify through a Labor Condition Application that they'll pay you at least the prevailing wage for your occupation and work location before USCIS will approve the petition. The DOL sets four wage levels based on experience and supervisory responsibilities. Use the OFLC Wage Search to look up the current wage tiers for your metro area so you can evaluate any offer against the legal minimum before signing.
Can I transfer my H-1B to a new employer if I change provider relations jobs?
Yes, H-1B portability lets you move to a new employer once they file a transfer petition with USCIS and you receive the receipt notice, as long as your previous H-1B was approved and you've maintained valid status. You can start the new job upon receipt without waiting for approval. The key is timing: your new employer needs to have the petition ready to file on or before your last day with the previous employer.
Does working remotely affect my H-1B status as a Provider Relations Representative?
Remote work creates a worksite location issue under H-1B rules. Your employer's LCA must cover the geographic area where you actually work, not just their headquarters. If you'll be working from home in a different metro area than the one listed on your LCA, your employer may need to file an amended petition with USCIS and a new LCA for your home location. Confirm this with your employer before agreeing to any remote arrangement.