What are the responsibilities and job description for the Provider Relations Specialist position at TechMind RPO?
About the Role
Are you passionate about transforming healthcare delivery and improving patient outcomes? We're seeking a dynamic Provider Engagement Account Executive to serve as a vital link between a major health organization and its provider network in the Queens and Bronx areas. This hybrid position offers a mix of field work and remote flexibility, with company-provided equipment for home-based work.
In this role, you will forge strategic partnerships with provider networks, enhance care quality, and improve clinical and operational outcomes through performance-based collaboration. You'll also use data-driven insights to support value-based care initiatives and ensure alignment with performance targets.
Key Responsibilities
- Conduct frequent in-person meetings with providers (30–50% of time) to support performance improvement and discuss quality metrics.
- Collaborate with providers on value-based care agreements and align on outcomes, cost efficiency, and quality metrics.
- Analyze performance data to offer actionable insights that improve provider delivery and outcomes.
- Lead issue resolution for high-dollar or high-volume claims and provider-related inquiries.
- Present performance analytics and recommendations to senior stakeholders during Joint Operating Committee (JOC) meetings.
- Provide education on referrals, claims, web tools, EDI, and operational procedures.
- Serve as a team lead for external representatives; provide training and mentorship.
- Work cross-functionally with internal departments and external provider executives.
- Travel locally within Queens and the Bronx approximately 4 days per week.
Requirements
- Bachelor's degree in healthcare, public health, or related field (Master's degree preferred).
- 5 years of experience in managed care, provider relations, clinical operations, or quality improvement.
- Hands-on experience conducting face-to-face provider visits to review performance metrics.
- Background in project management within health plan, IPA, or medical group settings.
- Strong grasp of HEDIS/Quality measures, utilization, and cost management.
- Demonstrated ability to work with executive leadership and influence change.
- Valid driver's license and ability to travel locally.
Skills Required
- Provider relationship management
- Data-driven performance analysis
- Value-based care strategies