Provider Relations Specialist

Position Summary: The Provider Relations Specialist is the mission-critical linchpin between HealthCare Partners and our network of primary care physicians. This role focuses on fostering strong working relationships with PCPs and staff in an ongoing effort to advance HCP’s organizational objectives, facilitate value based care, and improve both provider satisfaction and member health. The Provider Relations Specialist leverages data and knowledge of the primary care setting to identify PCP opportunities and tailor strategic action plans to support success. The Provider Relations Specialist serves as an internal subject matter expert with regard to their territory and collaborates cross departmentally to engage physicians optimally. This unique role blends a service and consultative approach to ensure HCP achieves its mission.

Essential Position Functions/Responsibilities:

• Establish and maintain collaborative relationships with PCPs and their staff through regular touchpoints, acting as the primary liaison between HCP and the provider network.
• Educate providers on HCP’s value-based care model, ensuring alignment with organizational goals and objectives.
• Spend approximately 90% of scheduled work time conducting face-to-face provider office visits.
• Provider Relations Specialists are expected to spend approximately 4.5 days each week in the field, with approximately 0.5 day reserved for administrative responsibilities, including scheduling, documentation, reporting, and internal meetings, based on business needs.
• Proactively identify and address provider concerns, leveraging data and analytics to tailor strategic action plans.
• Serve as a point of contact on provider relations, offering guidance to internal teams and stakeholders.
• Provide strategic insights and recommendations to providers on optimizing performance in key metrics such as HEDIS, HCC, and STAR ratings.
• Collaborate with cross-functional teams—including Quality, Risk Adjustment, and Care Management—to drive performance improvement and ensure seamless provider support.
• Continuously evaluate processes and recommend improvements to enhance provider relations and streamline operational workflows.
• Maintain up-to-date knowledge of industry regulations, trends, and payer policies to provide informed guidance to providers.

Qualification Requirements:
Skills, Knowledge, Abilities

• Strong desire and ability for creative problem solving and customer centric focus.
• Strong customer service and “soft-skills.” Ability to interface with physicians and staff in a positive and professional manner to create alignment and achieve common goals.
• Strong knowledge of primary care office operations and managed care models preferred.
• General understanding of HCC, Stars, HEDIS and their role in physician reimbursement/ incentives preferred.
• Proven ability to manage multiple projects simultaneously.
• Ability to work well independently.
• Ability to work well in groups.
• Excellent oral and written communication/ presentation skills.
• Proficiency in Microsoft Outlook, Excel, Word and PowerPoint.
• Valid Driver’s License and Motor Vehicle Insurance.

Training/Education:

• Bachelor’s degree in healthcare, business administration or equivalent working field experience, required.
• Non-Bachelor’s degree in clinical discipline considered.

Experience:

• Two or more years’ experience in HMO, IPA or medical group, Physician Management Company, or other managed care organization.
• Consulting or Account Management experience considered.

HealthCare Partners, MSO is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities (EEO) to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other protected status under federal, state, or local laws. In compliance with all applicable laws, HealthCare Partners, MSO upholds a strict non-discrimination policy in every location where we operate. This policy applies to all aspects of employment, including but not limited to recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Job Disclaimer:
The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.