Provider Relations Specialist Job at Personify Health

Job Description

Serves as a key relationship and operational liaison between group and the organization’s Care Management/Utilization Management (CM/UM) programs. This non-licensed role supports provider engagement, education, and issue resolution related to referrals, prior authorization/intake processes, and care management programs. The Provider Liaison partners with internal UM/CM, Intake, Claims, Network, and Operations teams to ensure providers have clear guidance, timely responses, and consistent service—supporting compliant, high-quality care and a positive provider experience.

Job Responsibility

Serves as a key relationship and operational liaison between group and the organization’s Care Management/Utilization Management (CM/UM) programs
Supports provider engagement, education, and issue resolution related to referrals, prior authorization/intake processes, and care management programs
Partners with internal UM/CM, Intake, Claims, Network, and Operations teams to ensure providers have clear guidance, timely responses, and consistent service
Serve as a primary point of contact regarding CM/UM programs, intake/prior authorization workflows, and general operational questions related to MyCare Platform
Build professional, service-oriented relationships with provider offices, facilities, and ancillary organizations through outbound outreach (phone/email/virtual meetings) and timely follow-up
Respond to routine provider inquiries
research and resolve issues within defined turnaround times, using established policies, job aids, and escalation pathways
Provide basic education to providers and office staff on submission requirements, required documentation, timelines, and available CM/UM resources
Route requests to the appropriate internal team (Intake, UM/UR, CM, Claims, Network, Operations) and monitor through closure
communicate status updates to providers as appropriate
Document provider interactions, inquiries, and outcomes accurately in designated systems
maintain complete, professional records
Support provider experience initiatives by identifying service gaps, reporting recurring issues, and recommending updates to job aids or FAQs
Build and maintain professional, collaborative relationships with physician practices, facilities, and other healthcare organizations
Respond to provider inquiries related to authorizations, care management workflows, claims coordination, policies, and billing escalation pathways
Educate providers and office staff on health plan requirements, benefits, prior authorization processes, and care management programs
Conduct routine provider outreach via phone, email, virtual meetings, or site visits as assigned
Collaborate with internal departments (UM, CM, Claims, Network, Operations) to resolve provider concerns in a timely and professional manner
Complete all required annual compliance and regulatory training within established timeframes
Ensure adherence to HIPAA, confidentiality standards, and minimum necessary requirements

Requirements

High school diploma or equivalent required
associate's or bachelor's degree in healthcare administration, business, public health, or related field preferred
1+ years of experience in a healthcare administrative, health plan, provider services, call center, or related role (managed care/TPA experience preferred)
Proficiency with Microsoft Office (Outlook, Word, Excel) and ability to learn internal platforms and provider portals (e.g., Availity or similar) as required
Basic computer literacy
The ability to work on multiple screens, and proficient typing skills
Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Outlook Excellent verbal and written communication skills
Ability to speak clearly and convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
Ability to work independently and utilize resources to problem solve
Higher education degree preferred
Additional proficiencies in Microsoft suite to include SharePoint, and Smartsheet with data analytics
Knowledge of Availity platform preferred

What we offer

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions
Paid Time Off
Mental health support, retirement planning, and financial protection
Professional development with clear career progression and learning budgets
Mission-driven culture where diverse perspectives drive real impact on people's health

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Provider Relations Specialist

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