Provider Relations Representative Jobs
Provider Relations Representative jobs are open across healthcare, managed care, insurance, and hospital networks, from entry-level coordinator roles to senior and lead positions, with specializations in network development, provider contracting, and credentialing support. Find a role that fits from the openings below and apply directly.
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Showing 5 of 12+ Provider Relations Representative jobs
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.
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 Provider Relations Representative Jobs
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Find JobsProvider Relations Representative Job Market
A snapshot from current openings nationwide, updated as new roles post.
Who's Hiring
- Molina Healthcare5
- Optum2
- Sheppard Pratt2
- Clever Care Health Plan1
- CommunityCare1
Top Industries Hiring
- Healthcare & Medical Services10
- Insurance2
- Non-Profit & Social Services1
What Employers Look For
The qualifications that appear most often in provider relations representative jobs.
- Experience managing provider relationships within a health plan, managed care, or hospital network
- Familiarity with credentialing processes, CAQH, and provider enrollment workflows
- Knowledge of provider contract terms, fee schedules, and network participation agreements
- Proficiency with CRM systems and provider data management platforms
- Strong written and verbal communication skills for resolving provider disputes and inquiries
- Associate or bachelor's degree in healthcare administration, business, or a related field
Tips for Your Provider Relations Representative Job Search
Tailor your resume to contract language
Hiring managers for provider relations roles scan for contract negotiation and provider agreement experience. Pull exact phrases from each job posting, such as 'network adequacy' or 'fee schedule,' and mirror them in your bullet points so your resume clears automated screening.
Highlight your provider dispute resolution wins
Employers want candidates who've resolved credentialing denials, billing disputes, or network participation issues. Describe the type of conflict, the parties involved, and the outcome you reached, even if you can't share proprietary numbers. Concrete examples outperform vague relationship-management claims.
Filter openings by payer type before applying
Provider relations roles at a commercial health plan differ meaningfully from those at a Medicaid managed care organization or a hospital system. Identify which payer environment matches your background and target those openings first, so your cover letter speaks directly to that audience.
Apply early to roles that fit
Migrate Mate lists provider relations representative openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Prepare for credentialing system questions in interviews
Interviewers routinely ask about CAQH, PECOS, or proprietary credentialing platforms you've worked in. Be ready to describe a specific workflow you managed in one of these systems, including how you tracked provider status changes and escalated stalled applications.
Follow up after interviews with a provider relations angle
Send a follow-up note within 24 hours that references a specific challenge the team mentioned, such as network gap closures or provider satisfaction scores, and briefly connects it to your experience. Generic thank-you notes rarely move the needle for these roles.
Provider Relations Representative Jobs: Frequently Asked Questions
Which companies are hiring the most provider relations representatives?
The companies hiring the most provider relations representatives right now include Molina Healthcare, Optum, and Sheppard Pratt, with the largest share of openings in California, Maryland, and New York, based on current listings on Migrate Mate as of June 2026. Health plans, Medicaid managed care organizations, and large hospital systems consistently post the highest volume of these roles.
How many provider relations representative jobs are remote?
About 42% of provider relations representative openings are fully remote or hybrid as of June 2026, with remote availability varying by employer type and region. Roles focused on phone-based provider inquiries and credentialing support tend to be the most remote-friendly, while positions tied to on-site network development or in-person provider outreach are more likely to require regular travel or a fixed office location.
How do you become a provider relations representative?
Most provider relations representatives start by building a foundation in healthcare administration, customer service, or billing. Earning an associate or bachelor's degree in healthcare administration or business strengthens your candidacy. Getting hands-on experience in a provider-facing support role, such as credentialing coordinator or member services, teaches the workflows and vocabulary that hiring managers expect. Familiarity with CAQH, provider enrollment, and managed care contracts makes your resume competitive for most openings.
Can you get a provider relations representative job with little experience?
Yes, entry-level provider relations representative roles exist, and employers often hire candidates from adjacent healthcare support positions. Experience in medical billing, credentialing assistance, or health plan member services transfers well because the core skills overlap. Demonstrating that you understand provider enrollment, can manage high call or case volumes, and communicate clearly with clinical staff or office managers will make up for a shorter direct-experience history.
What does the provider relations representative interview process look like?
The interview process typically starts with a phone screen from HR covering your background in healthcare and provider-facing roles. A second round with a hiring manager or team lead usually includes scenario-based questions about handling a provider dispute, explaining a contract change, or managing a credentialing backlog. Some employers add a written exercise or ask you to walk through how you'd resolve a specific network adequacy issue before extending an offer.
Where can I find and apply to provider relations representative jobs?
You can find and apply to provider relations representative jobs on Migrate Mate, which lists current openings from across the United States. Find roles that match your background, seniority level, and preferred work setting, then apply directly to each listing that fits.
See All Provider Relations Representative Jobs
Jump back to the full list of openings and apply to any provider relations representative role that fits.
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