Provider Relations Representative

Duties & Responsibilities:

• Serve as the liaison between providers and the Provider Relations Lead (PRL), addressing network issues and supporting provider relationships.

• Conduct provider training, education, and in-person visits to ensure compliance with policies and procedures.

• Assist the PRL in reporting and training on On-Time Performance (OTP), missed trips, and driver adherence projects to meet Health Plan expectations.

• Assist in recruiting, negotiating, and contracting providers to maintain network adequacy across assigned regions.

• Investigate and resolve provider complaints, claim issues, and service concerns.

• Perform field inspections to monitor provider performance, safety practices, and service quality.

• Support monthly provider touchpoints, quarterly reviews, and overall provider communications.

• Maintain provider records and documentation using PDM and ensure credentials remain current.

• Travel to Facilities and Provider offices as needed.

• High school diploma or equivalent; Spanish proficiency is a plus.

• 2+ years of related experience in provider relations, claims, or customer service; experience with Podiatry/Chiropractic networks is a plus.

• Proficient in Microsoft Word, Excel, PowerPoint, and Outlook.

• Strong communication, customer service, problem-solving, and analytical skills.

• Ability to work independently and collaboratively in the field or office.

• Observational, investigative, and process-oriented with attention to detail.

The Provider Relations Representative serves as the primary liaison between Alivi and its network of Non-Emergency Medical Transportation (NEMT) providers. Reporting to the Provider Relations Lead, this role supports departmental goals by building and maintaining strong provider relationships through training, education, and ongoing guidance delivered via in-person visits, virtual meetings, and phone communication. The Provider Relations Representative also assists the Lead in ensuring network adequacy by identifying, recruiting, negotiating, and contracting quality NEMT providers to meet organizational and member needs.