Summary:

The Provider Relations Representative role requires frequent travel throughout their assigned areas. This high-impact role serves as a key liaison between Genuine Health Group and its provider networks, driving performance across quality metrics, risk adjustment, and total cost of care. The ideal candidate brings deep knowledge of value-based care models and excels at building trust-based partnerships with physicians and practice leaders. Leveraging data insights and field expertise, the Provider Relations Representative delivers targeted education, monitors key financial and clinical indicators, and leads strategic interventions to improve outcomes and provider satisfaction. This role is critical to strengthening engagement, supporting sustainable growth, and ensuring our providers thrive in today’s evolving healthcare landscape.

Essential Duties and Responsibilities:

• Serve as the primary liaison between assigned provider groups, Genuine Health, and health plan partners, ensuring clear communication and alignment on shared performance goals.
• Deliver education and ongoing training to providers and staff on value-based care, health plan programs, operational workflows, and performance expectations.
• Maintain proactive communication to resolve issues related to claims, eligibility, utilization, quality metrics, and risk adjustment.
• Monitor provider performance against KPIs, including Genuine Rewards benchmarks, and provide tailored insights to support improvement.
• Collaborate with providers on performance improvement plans targeting clinical quality, financial sustainability, and patient outcomes.
• Lead provider meetings, including scheduling, agenda creation, and documentation of follow-ups.
• Work cross-functionally with departments such as Quality, MRA, Case Management, and Contracting to support practice success.
• Partner with Contracting to ensure accuracy of provider data and facilitate updates.
• Participate in internal strategy meetings to share field insights and inform planning.
• Conduct regular in-person visits (60% of the week) as part of Genuine Health’s high-touch engagement model.
• Build and maintain long-term provider partnerships through responsive support and collaborative problem-solving.
• Support outreach to specialists and ancillary providers to promote referral quality and care coordination.
• Drive improvements in Star ratings, risk scores, and medical cost containment across panels.
• Support broader goals in member retention, provider satisfaction, and quality initiatives.
• Stay current on CMS regulations and align provider support strategies accordingly.
• Perform other duties as assigned.

Knowledge, Skills and Abilities

• Deep understanding of Medicare Advantage, CMS regulations, HEDIS, Star Ratings, and Medicare Risk Adjustment (HCC coding).
• Strong knowledge of value-based care models, ACO operations, and managed care delivery systems.
• Ability to interpret and apply contractual terms, provider performance data, and incentive program structures.
• Proven ability to analyze and act on clinical, financial, and operational data to influence provider behavior and improve performance.
• High emotional intelligence with strong relationship-building, conflict resolution, and negotiation skills.
• Excellent communication skills in both English and Spanish (written and verbal), with the ability to educate and influence diverse provider audiences.
• Strong organizational and time-management skills with the ability to prioritize multiple high-impact initiatives.
• Demonstrated ability to lead provider meetings and trainings with clarity, professionalism, and purpose.
• Intermediate to advanced proficiency in Microsoft Excel (e.g., pivot tables, VLOOKUP, filtering), as well as PowerPoint, Outlook, and Teams.
• Ability to work independently and collaboratively in a field-based role that requires consistent travel and adaptability.
• Deep commitment to quality improvement, provider engagement, and delivering exceptional patient-centered care.

Minimum Education and Experience

• 5+ years of experience in a healthcare-related role required; preference for candidates with backgrounds in Medicare Advantage, ACOs, or Managed Services Organizations (MSOs).
• 3+ years of experience in Provider Relations, Network Management, Contracting, or Credentialing, with direct experience engaging physician groups and driving performance outcomes.
• Bachelor’s degree preferred in Health Administration, Business, or a related field (or equivalent combination of education and experience).
• Demonstrated experience working with CMS regulations, HEDIS, Star Ratings, and Medicare Risk Adjustment (HCC coding).
• Proven ability to analyze and act on clinical and financial performance data (e.g., MLR, utilization, gaps in care).
• Experience collaborating cross-functionally with internal teams such as Quality, Risk, Case Management, and Contracting.
• Bilingual fluency in English and Spanish – written and verbal – is preferred.
• Prior experience in a field-based, provider-facing role with regular travel is strongly preferred.
• Valid Florida driver’s license, clean driving record, and reliable transportation required.

Note: Nothing in this job specification restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Critical features of this job are described under various headings above. They may be subject to change at any time due to reasonable accommodation or other reasons.   The above statements are strictly intended to describe the general nature and level of the work being performed. They are not intended to be construed as a complete list of all responsibilities, duties, and skills required of employees in this position.