Provider Relations Specialist

Overview Who We Are Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives. Learn even more about the work that drives us at personifyhealth.com. Responsibilities Ready to What You'll Actually Do ESSENTIAL DUTIES and RESPONSIBILITIES: 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. ESSENTIAL DUTIES AND RESPONSIBILITIES 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. Document provider interactions, inquiries, and resolutions accurately in designated systems. 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. Qualifications What You Bring to Our Team Key Competencies Ability to perform the essential job functions safely and successfully with or without reasonable accommodation, including meeting qualitative and/or quantitative productivity standards. 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. UPON HIRE, must have: 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. Physical and Mental Requirements: Ability to perform the essential job functions safely and successfully with or without reasonable accommodation, including meeting qualitative and/or quantitative productivity standards. Ability to maintain regular, punctual attendance. Ability to sit for 6-8 hours. Constant use of computer keyboard and mouse; repetitive use of both hands. Occasional to frequent twisting of neck; frequent bending of neck and at waist Benefits The Highlights: Competitive base salary and benefits effective day one Comprehensive medical and dental through our own health solutions (yes, we use what we build) Paid Time Off—rest and recharge time is non-negotiable 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 Want the full picture? Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks. Compensation: This position offers a base salary range of $24-$29 per hour, depending on location, skills, and experience. You're eligible for our full benefits package starting day one. Our Commitment: Personify Health is an equal opportunity employer committed to diversity, equity, inclusion, and belonging. We cultivate a work environment where differences are celebrated, and employees of all backgrounds are empowered to thrive—because diversity is core to who we are and critical to our work in health and wellbeing. Stay Safe: Personify Health will never ask for payment or sensitive personal information like social security numbers during hiring. All official communication comes from verified company email addresses and or our secure applicant tracking system. Suspicious requests? Report them to [email protected]. View all legitimate openings at personifyhealth.com/careers.