Senior Provider Relations Representative at UPMC

DuBois, Pennsylvania, United States -

Full Time

Start Date

Immediate

Expiry Date

25 Apr, 26

Salary

0.0

Posted On

26 Jan, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Communication, Relationship Building, Customer Service, Education, Field Engagement, Healthcare Operations, Provider Services, Documentation, Onboarding, Training, Collaboration, Problem Solving, Travel, Behavioral Health Knowledge, Claims Management, Contracting

Industry

Hospitals and Health Care

Description

Are you passionate about building strong relationships and supporting healthcare providers? As a Provider Relations Representative, you’ll be the go-to contact for a panel of providers—helping them navigate policies, processes, and systems to deliver quality care to our members. This role combines customer service, education, and field engagement. You’ll spend time both in the office and in the community, ensuring providers have the tools and support they need. This is a hybrid role that offers a dynamic mix of community engagement and flexibility. In this role you will travel to meet with providers and attending local events. You will also have occasional in-office meetings, while also enjoying options to work from home. What You’ll Do: Serve as the primary contact for assigned providers, offering guidance on claims, authorizations, credentialing, and contracting. Build strong relationships through regular outreach, meetings, and follow-ups. Educate providers on Community Care policies, procedures, and product differences. Coordinate service schedules and ensure consistent phone coverage with your team. Maintain accurate documentation of provider interactions and action plans. Support provider onboarding, orientations, and training sessions. Collaborate with internal teams to resolve provider issues and share feedback. Travel within the network for face-to-face meetings and community engagement events. Facilitate meetings with high-needs providers and external stakeholders. Contribute to provider newsletters, manuals, and educational materials. What We’re Looking For: Strong communication and relationship-building skills Ability to manage multiple priorities and work independently Willingness to travel based on business needs Knowledge of healthcare operations and provider services Bachelor’s degree in healthcare, human services, or a related field 2 years of experience in a complex organizational environment Experience in behavioral health services or knowledge of the behavioral health provider system strongly preferred Excellent written and verbal communication skills Ability to clearly and consistently explain standards of care and provider agreements At least 2 years of experience in a healthcare or managed care setting Understanding of public and private behavioral health care delivery systems Licensure, Certifications, and Clearances: Act 34 UPMC is an Equal Opportunity Employer/Disability/Veteran

Responsibilities

Serve as the primary contact for assigned providers, helping them navigate claims, authorizations, credentialing, and contracting. Build strong relationships through regular outreach and ensure providers have the necessary tools and support.