Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
Remote - The Provider Relations Specialist is responsible for managing and maintaining timely and professional solutions to Provider escalations. This role ensures urgent and complex concerns are resolved with empathy, urgency, accuracy, and full ownership aligned with Caring Connections. This role maintains strong relationships with healthcare providers and ensures efficient provider operations across the contracted network (PCP, Specialists, Ancillary/Facility). This role independently manages provider-related activities and contributes to the resolution of complex Provider and member issues, including escalations related to provider data, claims, credentialing, and portal access.
Working collaboratively with regional provider groups, Customer Experience, and IPA partners, the Specialist supports the coordination and resolution of inquiries, exercising sound judgment to ensure timely, accurate, and compliant outcomes. The role facilitates key processes, including Notice of Changes (NOC), credentialing submissions, Letter of Agreements (LOA), portal access, and PCP terminations, while identifying opportunities to improve workflows and enhance the provider and member experience.
Job Duties/Responsibilities:
- Serve as a key liaison supporting regional provider groups by resolving inquiries and escalations related to PDM, claims processing, and portal access; provide guidance via email and assist inbound BPO operations to ensure timely and accurate issue resolution
- Model Caring Connections behaviors in all written and verbal communication ensuring professional courteous and timely resolution
- Oversee and manage provider-related escalations originating from Customer Experience, ensuring appropriate prioritization, investigation, and resolution while maintaining high standards of service delivery
- Establish and maintain collaborative relationships with Independent Practice Associations (IPAs) to proactively address and resolve member-related issues; coordinate across internal and external stakeholders to ensure timely resolution, mitigate service disruptions, and enhance the overall member and Provider experience
- Facilitate the submission and transformation of Notices of Change (NOCs) and credentialing (Cred) applications on behalf of provider groups, ensuring compliance with organizational policies and regulatory requirements
- Administer and process provider Letters of Agreement (LOAs), ensuring accuracy, completeness, and alignment with contractual and operational standards
- Coordinate and execute provider portal access requests, including provisioning, updates, and troubleshooting to support seamless system utilization
- Manage Primary Care Provider (PCP) termination requests, ensuring proper documentation, system updates, and adherence to established workflows and timelines
- Attends and participates, on camera, in all staff meetings as required
- Other duties as assigned
Job Requirements:
Experience:
- Required: Minimum 2 years of experience in provider relations / contracting with an HMO or IPA, medical group or institutional provider required
- Preferred: 5 years in field
Education:
- Required: High School Diploma or GED
- Required: Bachelor's degree (preferred) or required four years of additional experience in lieu of education
- Preferred: MBA
Specialized Skills:
• Required:
- Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others
- Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors
- Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
- Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution
- Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment
- Report Analysis Skills: Comprehend and analyze statistical reports
Licensure:
• Required: None
Essential Physical Functions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear.
- The employee is frequently required to walk, stand; reach with hands and arms.
- The employee is occasionally required to climb or balance and stoop, kneel, crouch, or crawl.
- The employee must occasionally lift and/or move up to 20 pounds.
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.
If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact careers@ahcusa.com.
Pay Range: $58,531.00 - $87,797.00
Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.
*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.