Provider Relations Representative

Join Our Team at Phoebe as a Provider Relations Representative!

At Phoebe, we’re more than a healthcare system—we’re a community committed to compassion, excellence, integrity, and teamwork. Our mission is to deliver exceptional care and strengthen the health of the communities we serve. If you’re passionate about building strong provider partnerships, enhancing communication, and supporting a high‑performing network, we’d love for you to join our team.

As a Provider Relations Representative, you will:

• Serve as a vital connection between PHP and our provider community.
• Support smooth daily operations across the provider network.
• Strengthen and maintain positive provider relationships.
• Deliver exceptional service and responsive support to all PHP providers.

Qualifications:

Education:

• Associate’s Degree in Healthcare, Marketing, Business, or related field (Required)
• Bachelor’s Degree in Healthcare, Marketing, Business, or related field (Preferred)

Experience:

• Minimum 1 year of experience in managed care operations, including:
  • PPO network operations
  • Coding and compliance
  • Provider billing, registration, and authorization procedures
  • Reimbursement methodologies
  • Claims processing
  • Revenue management

Knowledge, Skills & Abilities:

• Strong organizational and communication skills
• Effective interpersonal and customer‑relations abilities
• Proficiency in grammar, spelling, written and verbal communication
• Ability to comprehend written instructions and follow verbal directions
• Basic computer and Microsoft Office skills
• General clerical capabilities
• Knowledge of healthcare billing processes

Core Competencies:

Accountability & Performance Improvement:

• Produces high‑quality work with accuracy and timeliness.
• Admits and learns from mistakes.
• Adapts to new ideas and changing processes.
• Completes all required training and timekeeping responsibilities.

Job Knowledge:

• Demonstrates strong understanding of role responsibilities and required technical knowledge.
• Quickly applies new skills and supports others in learning best practices.

Professionalism & Ethics:

• Maintains professional and ethical behavior at all times.
• Protects confidentiality and collaborates effectively with the healthcare team.

Communication:

• Communicates clearly, listens actively, and handles conflicts constructively.

Integrity:

• Follows the organization's Code of Conduct, Mission, Vision, and Values.
• Reports concerns appropriately and maintains honesty in all interactions.

Essential Functions:

Provider Issues Resolution:

• Perform duties required to resolve customer and provider issues.
• Respond to and assist in resolving issues reported by PHP providers and other internal/external sources.
• Provide timely follow‑up and related correspondence.
• Serve as a liaison to providers and networks by assisting with issue resolution, claims concerns, and information needs.
• Receive inquiries and respond within 72 hours.
• Document issues and escalate consistent patterns to the Manager.
• Submit written reports when three similar issues arise from different sources, or immediately for isolated but severe issues.

Provider Advocate:

• Support the regional provider community through proactive engagement.
• Develop and maintain effective business relationships with physicians, hospitals, allied health professionals, and ancillary providers within the PHP service area.
• Interface with PHP leadership—including the Executive Director, Medical Director, Board of Directors, and committees—to communicate provider needs and emerging issues.
• Contribute to the creation of marketing materials and tools that promote PHP to the business community.
• Monitor provider activities and stay current on trends, legislation, and changes affecting providers and managed care operations.
• Prepare and distribute necessary provider communications such as newsletters, contract updates, network changes, and other official correspondence.

Provider Liaison:

• Provide high‑level service to PHP provider members.
• Serve as the primary liaison between PHP and provider members, facilitating claims resolution, problem‑solving, and information sharing.
• Act as a technical resource for complex provider issues, escalating trends to management as needed.
• Develop new provider programs addressing systemic issues related to customer service, systems, contract implementation, and more.
• Recommend and implement procedural improvements to enhance service quality.

Additional Duties:

• Adhere to hospital and departmental attendance and punctuality guidelines.
• Perform all job responsibilities in alignment with the mission, vision, and core values of the organization.
• Maintain current knowledge through continued education and training.
• Attend required staff meetings, in‑services, and complete mandatory competencies on time.
• Follow departmental policies and procedures for all job functions.
• Demonstrate competency in providing appropriate service based on patient or customer needs.
• Utilize protective clothing and equipment as appropriate.