Provider Relations Representative Jobs
Provider Relations Representative jobs are open across healthcare, insurance, managed care, and government programs, at every level from entry-level coordinator to senior and manager, with specializations in credentialing, network development, and provider engagement. See the openings below and apply to the ones that match your experience.
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Showing 5 of 96+ Provider Relations Representative jobs
Description
About the Role
The Market Provider Relations Specialist partners closely with physicians, practice leadership, and care teams to identify operational and clinical improvement opportunities, implement value-based care strategies, and support achievement of organizational performance goals. Through provider education, performance analysis, workflow optimization, and ongoing relationship management, this role helps practices improve patient outcomes, documentation accuracy, operational effectiveness, and financial performance.
The ideal candidate is relationship-driven, analytical, and passionate about helping providers succeed in a value-based care environment.
Our Values
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What You'll Do
- Serve as the primary point of contact for assigned provider practices and build strong relationships with physicians, office managers, practice administrators, and clinical staff
- Conduct provider meetings and site visits to review performance, discuss initiatives, address challenges, and support improvement efforts
- Support provider engagement, practice transformation, quality improvement, risk adjustment, utilization management, and value-based care initiatives
- Educate providers and practice staff on HEDIS, CMS Star Ratings, risk adjustment, documentation requirements, population health, and quality improvement programs
- Review provider performance reports and scorecards, identify improvement opportunities, and assist with development of action plans
- Support providers in improving documentation accuracy, coding practices, care gap closure, chronic disease management, and patient outcomes
- Assist with operational questions related to claims, referrals, authorizations, credentialing, provider data, and other provider service functions
- Partner with Quality, Risk Adjustment, Care Management, Medical Management, Claims, Contracting, Credentialing, and Operations teams to support provider success
- Monitor provider engagement activities, maintain accurate documentation, and provide updates on market and provider performance
- Support implementation of new programs, payer initiatives, regulatory requirements, and organizational priorities
Qualifications
- Bachelor's degree in Healthcare Administration, Public Health, Nursing, Business Administration, or a related field preferred, or an equivalent combination of education and relevant healthcare experience
- Minimum of three (3) years of experience in provider relations, healthcare operations, managed care, practice management, quality improvement, population health, risk adjustment, or a related healthcare field
- Experience working directly with physician practices preferred
- Experience supporting value-based care programs preferred
- Knowledge of provider office operations and healthcare delivery models
- Working knowledge of HEDIS, CMS Star Ratings, quality improvement, and risk adjustment principles
- Understanding of managed care, Medicare Advantage, ACOs, IPA operations, or population health programs preferred
- Strong analytical skills with the ability to interpret provider performance data and translate findings into actionable recommendations
- Strong relationship-building, communication, presentation, and facilitation skills
- Strong organizational and project management abilities with the ability to manage multiple priorities and deadlines
- Proficiency with Microsoft Office applications and reporting tools
- Experience supporting provider performance improvement initiatives
- Experience working within Medicare Advantage, Medicaid, ACO, IPA, or other value-based care models
- Experience with provider education, workflow optimization, and practice transformation initiatives
- Familiarity with utilization management, population health, and care coordination programs
Environmental Job Requirements and Working Conditions
- Our organization follows a hybrid work structure where the expectation is to work in-office and remotely on a weekly basis. The office is located at 19500 Highway 249, Suite 570, Houston, TX 77070.
- Regular travel throughout the assigned market, including visits to provider offices, clinics, and community locations, may be required.
- Ability to attend provider meetings, trainings, and market events as needed.
- The target pay range for this role is $75,000-$85,000 per year. Actual compensation will be determined based on geographic location, experience, qualifications, internal equity, and other job-related factors.
About Astrana Health, Inc.
Description
About the Role
The Market Provider Relations Specialist partners closely with physicians, practice leadership, and care teams to identify operational and clinical improvement opportunities, implement value-based care strategies, and support achievement of organizational performance goals. Through provider education, performance analysis, workflow optimization, and ongoing relationship management, this role helps practices improve patient outcomes, documentation accuracy, operational effectiveness, and financial performance.
The ideal candidate is relationship-driven, analytical, and passionate about helping providers succeed in a value-based care environment.
Our Values
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
What You'll Do
- Serve as the primary point of contact for assigned provider practices and build strong relationships with physicians, office managers, practice administrators, and clinical staff
- Conduct provider meetings and site visits to review performance, discuss initiatives, address challenges, and support improvement efforts
- Support provider engagement, practice transformation, quality improvement, risk adjustment, utilization management, and value-based care initiatives
- Educate providers and practice staff on HEDIS, CMS Star Ratings, risk adjustment, documentation requirements, population health, and quality improvement programs
- Review provider performance reports and scorecards, identify improvement opportunities, and assist with development of action plans
- Support providers in improving documentation accuracy, coding practices, care gap closure, chronic disease management, and patient outcomes
- Assist with operational questions related to claims, referrals, authorizations, credentialing, provider data, and other provider service functions
- Partner with Quality, Risk Adjustment, Care Management, Medical Management, Claims, Contracting, Credentialing, and Operations teams to support provider success
- Monitor provider engagement activities, maintain accurate documentation, and provide updates on market and provider performance
- Support implementation of new programs, payer initiatives, regulatory requirements, and organizational priorities
Qualifications
- Bachelor's degree in Healthcare Administration, Public Health, Nursing, Business Administration, or a related field preferred, or an equivalent combination of education and relevant healthcare experience
- Minimum of three (3) years of experience in provider relations, healthcare operations, managed care, practice management, quality improvement, population health, risk adjustment, or a related healthcare field
- Experience working directly with physician practices preferred
- Experience supporting value-based care programs preferred
- Knowledge of provider office operations and healthcare delivery models
- Working knowledge of HEDIS, CMS Star Ratings, quality improvement, and risk adjustment principles
- Understanding of managed care, Medicare Advantage, ACOs, IPA operations, or population health programs preferred
- Strong analytical skills with the ability to interpret provider performance data and translate findings into actionable recommendations
- Strong relationship-building, communication, presentation, and facilitation skills
- Strong organizational and project management abilities with the ability to manage multiple priorities and deadlines
- Proficiency with Microsoft Office applications and reporting tools
- Experience supporting provider performance improvement initiatives
- Experience working within Medicare Advantage, Medicaid, ACO, IPA, or other value-based care models
- Experience with provider education, workflow optimization, and practice transformation initiatives
- Familiarity with utilization management, population health, and care coordination programs
Environmental Job Requirements and Working Conditions
- Our organization follows a hybrid work structure where the expectation is to work in-office and remotely on a weekly basis. The office is located at 19500 Highway 249, Suite 570, Houston, TX 77070.
- Regular travel throughout the assigned market, including visits to provider offices, clinics, and community locations, may be required.
- Ability to attend provider meetings, trainings, and market events as needed.
- The target pay range for this role is $75,000-$85,000 per year. Actual compensation will be determined based on geographic location, experience, qualifications, internal equity, and other job-related factors.
About Astrana Health, Inc.
See All 96 Provider Relations Representative Jobs
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Find JobsProvider Relations Representative Job Market
Who's Hiring
- Independent Living Systems14
- American Health Plans9
- Health Care Service Corporation4
- L.A. Care Health Plan3
- SKYGEN2
Top Industries Hiring
- Insurance
- Healthcare & Medical Services
What Employers Look For
The qualifications that appear most often in provider relations representative jobs.
- Two or more years of experience in provider relations, credentialing, or healthcare contracting
- Proficiency with provider data management and credentialing platforms such as CAQH or PECOS
- Knowledge of managed care, Medicare, Medicaid, or commercial insurance plan structures
- Strong verbal and written communication skills for provider outreach and dispute resolution
- Associate or bachelor's degree in healthcare administration, business, or a related field
- Familiarity with contract terms, network adequacy standards, and provider appeals processes
Tips for Your Provider Relations Representative Job Search
Tailor your resume to credentialing workflows
Highlight experience with provider enrollment, credentialing databases, or contract management systems on your resume. Recruiters for these roles scan for familiarity with CAQH, PECOS, or similar platforms, so name the tools you have actually used.
Target listings by network type
Filter openings by payer type, such as commercial, Medicaid, or Medicare Advantage, because day-to-day workflows differ significantly. Matching your background to the right network type makes your application far more competitive than applying broadly.
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.
Quantify your provider outreach results
Instead of listing job duties, show outcomes: how many providers you onboarded, disputes you resolved, or network gaps you closed. Hiring managers in this field respond to numbers that demonstrate relationship management at scale.
Prepare for scenario-based interview questions
Interviewers frequently ask how you have handled a provider threatening to leave a network or a credentialing dispute that stalled. Prepare two or three concrete examples that show your ability to de-escalate and reach resolution.
Negotiate using your provider portfolio scope
When discussing compensation, reference the size and complexity of the provider network you managed, including specialty mix and geographic reach. This context anchors your value more effectively than job title comparisons alone.
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 Independent Living Systems, American Health Plans, and Health Care Service Corporation, with the largest share of openings in Florida, Texas, and California, based on current listings on Migrate Mate as of November 2026. Health plans, managed care organizations, and Medicaid managed care contractors consistently post the highest volume of these roles.
How many provider relations representative jobs are remote?
About 91% of provider relations representative openings are fully remote or hybrid as of November 2026, reflecting increased flexibility across the healthcare industry. Provider outreach, credentialing support, and dispute resolution roles tend to be the most remote-eligible, while positions involving in-person provider visits or local network development are more likely to require on-site presence.
How do you become a provider relations representative?
Start by building foundational knowledge in healthcare administration, insurance operations, or managed care through a degree program or entry-level work in a related role such as provider enrollment or member services. Gain hands-on experience with credentialing processes and provider data systems, then pursue roles that involve direct provider contact. Familiarity with payer structures and regulatory requirements strengthens your candidacy at every stage.
Can you get hired as a provider relations representative with little experience?
Yes, entry-level provider relations representative roles exist, particularly at health plans and third-party administrators that run structured training programs. Candidates with customer service, medical billing, or healthcare administrative backgrounds are frequently considered for these positions. Demonstrating knowledge of managed care terminology, showing comfort with database tools, and expressing genuine interest in provider partnerships can offset a shorter work history.
What does the provider relations representative interview process look like?
The process typically includes an initial phone screen with a recruiter focused on your healthcare background, followed by one or two interviews with a hiring manager and sometimes a panel from the network or contracting team. Expect behavioral questions about conflict resolution with providers, experience managing credentialing timelines, and scenarios involving network retention. Some employers add a brief written exercise or case study related to provider outreach or dispute handling.
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. Search for roles that match your background in areas like credentialing, network development, or provider outreach, and apply directly to each listing that fits your experience and preferred location or work arrangement.
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