Provider Relations Representative Jobs in USA with Visa Sponsorship
Provider Relations Representatives work in healthcare administration coordinating between insurers, hospitals, and medical networks. Employers in managed care and health systems regularly sponsor H-1B visa and TN visas for qualified candidates with degrees in healthcare administration, public health, or business. For detailed occupation requirements, see the O*NET profile.
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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 Provider Relations Representative Jobs
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Get Access To All JobsTips for Finding Provider Relations Representative Jobs
Target managed care and health plan employers
Large health insurers and managed care organizations file Labor Condition Applications for Provider Relations roles far more frequently than smaller clinics. Focus your search on employers with established HR infrastructure and a track record of sponsoring work visas.
Align your degree to the specialty occupation standard
H-1B approval depends on showing the role requires a specific bachelor's degree. Degrees in healthcare administration, public health, or business administration are the strongest fit for Provider Relations positions and support the specialty occupation argument most directly.
Highlight network contracting and credentialing experience
Employers sponsoring visas want candidates who reduce onboarding risk. Concrete experience with provider credentialing, contract negotiation, or claims resolution signals immediate value and strengthens the business case a hiring manager must make to justify sponsorship.
Understand TN eligibility if you hold Canadian or Mexican citizenship
TN visa classification covers certain business and management roles under USMCA. If your degree is in a qualifying field like business administration, TN may be available without the H-1B lottery, giving you a faster path to starting work.
Address the specialty occupation question proactively
Provider Relations is a role USCIS scrutinizes for H-1B eligibility. Come prepared to explain why your specific position requires a degree in a particular field, not just any bachelor's degree, using your job description and employer documentation as evidence.
Build experience in health information systems
Familiarity with systems like Epic, Facets, or similar provider management platforms strengthens your profile significantly. Employers sponsoring visas are especially motivated when candidates bring technical skills that are harder to source domestically on short timelines.
Frequently Asked Questions
Do employers commonly sponsor visas for Provider Relations Representative roles?
Sponsorship exists but is more common at large managed care organizations, regional health plans, and hospital networks than at smaller practices. Employers with dedicated HR and legal teams are better positioned to navigate H-1B visa filings. You can browse sponsoring employers currently hiring on Migrate Mate to identify which organizations have active openings.
Does a Provider Relations Representative role qualify as an H-1B specialty occupation?
It can qualify, but USCIS scrutinizes administrative healthcare roles closely. The key is demonstrating that the specific position requires a degree in a particular field, such as healthcare administration or public health, not just any bachelor's degree. Job descriptions that list specific degree requirements and employers who document this requirement in writing have stronger petition outcomes.
What degrees support an H-1B or work visa petition for this role?
Healthcare administration, public health, business administration, and health informatics are the most defensible degree fields for Provider Relations positions. A general business or communications degree can work if the employer's job description ties the role's duties directly to that field of study. The degree-to-job match is the core of the specialty occupation argument.
Can a Canadian citizen get a TN visa for a Provider Relations Representative position?
Possibly, if the role fits a covered TN category and your degree aligns. Management consultant or certain scientific or business analyst categories have been used for healthcare administrative roles, but TN classification requires a clear match between the USMCA category, the job duties, and your credentials. An immigration attorney can assess your specific situation before you apply.
What should I expect during the H-1B petition process for this type of role?
Your employer files a Labor Condition Application with the Department of Labor first, then submits Form I-129 to USCIS after the H-1B lottery selection. For administrative healthcare roles, USCIS sometimes issues Requests for Evidence challenging specialty occupation status. Having a detailed job description, an employer support letter explaining degree requirements, and documentation of your credentials reduces the risk of delays.
What is the prevailing wage requirement for sponsored Provider Relations Representative jobs?
U.S. employers sponsoring a visa must pay at least the prevailing wage, which is what workers in the same role, area, and experience level typically earn. The Department of Labor sets this rate to make sure companies aren't hiring foreign workers simply because they'd accept lower pay than a U.S. worker. It varies by job title, location, and experience. You can look up current prevailing wage rates for any occupation and location using the OFLC Wage Search page.