[Hiring] Provider Relations Coordinator @Acentra Health, LLC

Role Description

Acentra Health is looking for a Provider Relations Coordinator to join our growing team. The Provider Relations Coordinator supports provider recruitment, enrollment, onboarding, and ongoing provider relations activities to ensure effective participation in Acentra Health programs and systems. This position serves as a liaison between providers, clients, and internal teams, assisting with provider inquiries, claims and payment concerns, contract coordination, and provider education. The role also supports network reporting, accurate documentation, and continuous improvement of provider services to promote operational efficiency and positive provider relationships.

• Conduct outreach to client-identified providers through phone, email, and other communication channels to support provider recruitment and network development.
• Coordinate provider onboarding, screening, and enrollment activities, including explaining processes, assisting with required documentation, collaborating with the enrollment team, and resolving enrollment-related issues.
• Support practitioner and provider organization onboarding and retention efforts to maintain effective provider network participation.
• Review and prepare practitioner and provider organization contracts, including in-network, out-of-network, and single-case agreements.
• Respond to incoming provider and client inquiries regarding benefits, procedures, documentation, payments, and other program-related matters, ensuring timely resolution and appropriate follow-up.
• Manage customer service escalations, including phone queue and voicemail inquiries, in accordance with established workflows.
• Review and respond to provider claims appeals, grievances, and payment disputes, applying medical coding and billing knowledge to resolve pricing and payment concerns and document decisions.
• Maintain accurate provider and client records, including network information, provider responses, calls, case updates, requests, and referrals, in accordance with established procedures.
• Track provider outreach activities, assess geographic network coverage, and prepare accurate client reports related to provider network performance.
• Maintain provider policy documentation, communicate updates, and conduct provider training sessions and webinars to support understanding of program requirements, systems, and tools.
• Collaborate with technical teams to support accurate configuration of Medicare billing codes and reimbursement methodologies.
• Perform other duties as assigned to support internal and external customers and achieve client program objectives.
• Read, understand, and adhere to all corporate policies, including policies related to HIPAA and its Privacy and Security Rules.

Qualifications

• High school diploma or equivalent (bachelor’s degree preferred)
• 2+ years of provider-facing experience in healthcare, such as health plan/provider relations, medical billing, claims adjudication, or revenue cycle management, including experience resolving provider inquiries related to claims, pricing, and payments
• Working knowledge of medical coding and claims fundamentals, including CPT/HCPCS procedure codes, ICD-10 diagnosis codes, and familiarity with EOBs and 835/837 transaction concepts
• Basic familiarity with Medicare and Medicaid payment rules relevant to provider claims
• Proficiency in Microsoft Office applications, including Outlook, Excel, and Word, with accurate data entry skills

Requirements

• Advanced knowledge of Medicare claims payment rules and reimbursement methodologies
• Clinical coding certification
• Excellent verbal and written communication, negotiation, and customer service skills, with the ability to clearly explain provider enrollment processes and associated documentation
• Strong organizational and time management skills, with exceptional attention to detail and the ability to manage multiple priorities and meet established deadlines
• Ability to handle confidential business information and protected health information (PHI) with discretion
• Proficiency in reading and interpreting benefits and account information related to customized products
• Strong problem-solving skills, sound judgment, and the ability to make independent decisions

Benefits

• Comprehensive health plans
• Paid time off
• Retirement savings
• Corporate wellness
• Educational assistance
• Corporate discounts
• And more