Medical Network Provider Relations Manager

Location: Hybrid 3 days (offices in NYC, Denver, CO and Charlotte, NC area)

Position Summary

The Medical Network Provider Relations Manager is responsible for developing, managing, and strengthening relationships with healthcare providers, provider groups, facilities, and network partners. This role serves as the primary liaison between providers and the organization, ensuring provider satisfaction, network performance, contract compliance, and issue resolution. The Provider Relations Manager works closely with Network Development, Contracting, Claims, Operations, and Client Services teams to support provider engagement, optimize network performance, and drive strategic growth initiatives.

Position Responsibilities:

Provider Relationship Management

• Build and maintain strong relationships with healthcare providers, physician groups, hospitals, ancillary providers, and network partners.
• Serve as the primary point of contact for providers regarding operational, contractual, and service-related matters.
• Conduct regular provider outreach, meetings, and educational sessions to promote engagement and satisfaction.
• Develop and execute provider engagement strategies that support network growth and retention.

Provider Support and Issue Resolution

• Manage and resolve provider inquiries related to claims, reimbursement, network participation, credentialing, and operational processes.
• Collaborate with internal departments to investigate and resolve provider escalations in a timely manner.
• Monitor provider satisfaction trends and proactively address concerns.
• Ensure providers receive accurate and timely information regarding policies, procedures, and network requirements.

Network Management and Development

• Support provider recruitment, onboarding, and retention initiatives.
• Partner with Contracting and Network Development teams to identify network gaps and expansion opportunities.
• Assist with implementation of provider contracts and network participation agreements.
• Monitor provider performance and participation to ensure network adequacy and service excellence.

Provider Education and Communication

• Develop and deliver provider education programs regarding claims submission, reimbursement methodologies, policies, and operational processes.
• Communicate organizational updates, policy changes, and regulatory requirements to participating providers.
• Create and distribute provider newsletters, training materials, and communication resources.
• Facilitate provider meetings, webinars, and network forums.

Performance Analysis and Reporting

• Analyze provider performance metrics, service trends, and network utilization data.
• Develop reports and presentations for leadership regarding provider network performance and relationship management activities.
• Monitor key performance indicators (KPIs) such as provider satisfaction, issue resolution, and retention rates.
• Identify opportunities for process improvements and operational efficiencies.

Cross-Functional Collaboration

• Collaborate with Claims, Contracting, Credentialing, Provider Data Management, Operations, and Client Services teams.
• Act as a provider advocate within the organization to ensure provider perspectives are considered in decision-making.
• Participate in client meetings and strategic initiatives involving provider network management.
• Support implementations, acquisitions, network expansions, and special projects.

Compliance and Quality Assurance

• Ensure provider interactions and activities comply with contractual obligations, regulatory requirements, and company policies.  
• Ensure provider interactions comply with rented network guidelines and contractual obligations.
• Support internal and external audits related to provider network management.
• Maintain accurate documentation of provider communications, escalations, and resolutions.
• Promote compliance with network standards and performance expectations.

Required Qualifications:

• Bachelor's degree in Healthcare Administration, Business Administration, Healthcare Management, or a related field.
• Minimum 5 years of experience in provider relations, healthcare network management, account management, managed care, or healthcare operations.
• Strong knowledge of:
• Healthcare provider networks
• Claims processing and reimbursement methodologies
• Provider contracting and credentialing
• Managed care operations
• Healthcare regulations and compliance requirements
• Experience managing provider relationships and resolving complex provider issues.
• Excellent communication, negotiation, presentation, and interpersonal skills.
• Strong analytical and problem-solving abilities.
• Proficiency with Microsoft Office Suite and CRM or provider management systems.

Preferred Qualifications:

• Experience within a Third-Party Administrator (TPA), PPO network, health plan, managed care organization, or healthcare services company.
• Knowledge of workers’ compensation and medical-only network programs.
• Experience supporting nationwide provider networks.
• Familiarity with provider data management, network rental arrangements, and claims repricing operations.
• Professional certifications such as Certified Provider Relations Professional (CPRP) or related healthcare certifications.