Provider Relations Specialist

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Provider Relations Specialist based in the United States.

The Provider Relations Specialist supports healthcare providers with bill review questions and requests ranging from routine inquiries to complex billing issues.

This remote role combines provider communication, workers’ compensation knowledge, medical bill analysis, and customer service.

You will help providers understand processed medical bills, fee schedules, contracted rates, and client-specific billing requirements.

The position also plays an important role in identifying and documenting bill review errors to support quality improvement and reduce recurring issues.

You will work with providers and internal stakeholders through phone and email while maintaining timely, professional, and accurate service.

Success in this role requires strong attention to detail, sound judgment, effective communication, and the ability to navigate multiple systems and guidelines.

This is a strong opportunity for a customer-focused professional with workers’ compensation or bill review experience who enjoys solving problems in a collaborative, service-oriented environment.

Accountabilities:

• Communicate clearly, professionally, and efficiently with providers and other stakeholders through phone and email.
• Assist providers with bill review questions and requests of varying complexity, ensuring accurate and timely resolutions.
• Apply workers’ compensation guidelines and client-specific contract language when interpreting and explaining medical bill review outcomes.
• Navigate bill review applications and related systems to retrieve accurate information and respond effectively to provider inquiries.
• Interpret explanations of review (EORs) and account for client-specific billing requirements and nuances.
• Answer basic to complex questions regarding state workers’ compensation fee schedules and billing requirements for processed medical bills.
• Support inquiries involving both regular and facility medical bill types.
• Explain provider contracted rates, network agreements, and carve-outs applied to medical bills in a clear and professional manner.
• Identify and document bill review errors and trends to support quality improvement and help reduce team error rates.
• Manage phone conversations effectively to promote timely resolution and minimize provider hold times.
• Maintain compliance with established best practices and quality standards while delivering consistent provider service.
• Perform additional duties and responsibilities as assigned.

Requirements

• Associate degree is preferred, or comparable experience in workers’ compensation or a related field.
• Working knowledge of applicable state workers’ compensation regulations.
• Strong knowledge of fee schedules and network contracts.
• CPC certification and/or expert-level medical bill review analysis experience is preferred.
• Strong customer service experience with the ability to handle routine and complex provider inquiries professionally.
• Excellent verbal and written communication skills.
• Strong organizational and time-management abilities with excellent attention to detail.
• Excellent interpersonal skills and the ability to build productive relationships with providers and internal stakeholders.
• Proficiency with Microsoft Office applications, particularly Word and Excel.
• Ability to independently research, interpret, and explain billing information accurately.
• Ability to work effectively both independently and as part of a team.
• Strong problem-solving and analytical skills.
• Ability to control and manage phone conversations effectively while maintaining a positive and professional customer experience.
• Ability to prioritize multiple tasks and maintain accuracy in a fast-paced environment.
• Strong commitment to quality, consistency, and timely service delivery.

Benefits

• Pay range of $14.00-$23.42 per hour, depending on factors such as location, experience, qualifications, internal equity, and market conditions.
• Full-time employment opportunity.
• Fully remote work arrangement.
• Medical coverage, including HDHP options with pharmacy benefits.
• Dental and vision insurance.
• Long-term disability insurance.
• Health Savings Account (HSA).
• Flexible Spending Account (FSA) options.
• Life insurance.
• Accident insurance.
• Critical illness insurance.
• Pre-paid legal insurance.
• Parking and transit FSA accounts.
• 401(k) and Roth 401(k) options.
• Paid time off.
• Supportive, team-oriented work environment.
• Opportunities for professional development and career advancement.
• Opportunity to build expertise in workers’ compensation, medical bill review, provider relations, and healthcare services.