ജോലി വിവരണം

About the Company

Personify Health operates a personalized health platform that combines health plan administration, wellbeing support, and care navigation in one system. The organization works with employers, health plans, and health systems to lower costs while improving health outcomes, with a mission centered on helping people live healthier lives.

Role Summary

This position serves as a relationship and operations partner between provider groups and the company’s Care Management and Utilization Management programs. It is a non-licensed role focused on helping providers understand workflows, get issues resolved, and receive timely support across referrals, prior authorization, intake, and care management processes.

Key Responsibilities

Act as the main contact for questions about care management, utilization management, intake, prior authorization workflows, and general operational support tied to the MyCare platform.
Develop professional, service-focused relationships with provider offices, facilities, and ancillary organizations through calls, emails, virtual meetings, and follow-up.
Handle routine provider questions, investigate concerns, and resolve issues within expected turnaround times using established procedures and escalation paths.
Educate providers and office teams on submission requirements, required documentation, timelines, and available CM/UM resources.
Direct requests to the right internal teams, such as Intake, UM/UR, Care Management, Claims, Network, and Operations, while tracking them through resolution and sharing status updates when needed.
Accurately record provider conversations, inquiries, and outcomes in the appropriate systems.
Spot recurring service issues, share feedback on process gaps, and help improve job aids and FAQs.
Maintain collaborative working relationships with physician practices, facilities, and other healthcare organizations.
Address provider questions related to authorizations, care management processes, claims coordination, policy questions, and billing escalation steps.
Provide guidance on health plan requirements, benefits, prior authorization procedures, and care management programs.
Carry out scheduled provider outreach, including phone calls, email outreach, virtual meetings, and site visits when assigned.
Complete required annual compliance and regulatory training within the assigned deadlines.
Follow HIPAA rules, confidentiality standards, and minimum necessary requirements at all times.

Qualifications

Applicants should have a high school diploma or equivalent, with an associate’s or bachelor’s degree in healthcare administration, business, public health, or a related field preferred. At least 1 year of experience in healthcare administration, health plan operations, provider services, call center work, or a similar role is required; managed care or TPA experience is preferred. Candidates should be comfortable using Microsoft Office tools and learning internal systems and provider portals such as Availity or similar platforms.

Technical and Workplace Skills

On hire, the candidate should already have basic computer literacy, the ability to work across multiple screens, and strong typing capability. Strong verbal and written communication is essential, along with the ability to explain technical information clearly and understand complex information from others. The role also calls for independent problem-solving and familiarity with Microsoft Word, Excel, Outlook, and ideally SharePoint and Smartsheet with data analytics. Knowledge of the Availity platform is preferred.

Physical and Mental Requirements

The job requires the ability to perform essential functions safely and effectively, with or without reasonable accommodation, while meeting productivity expectations. Regular and punctual attendance is necessary. The role involves sitting for 6 to 8 hours, constant use of a keyboard and mouse, repetitive hand movement, and occasional to frequent twisting of the neck as well as frequent bending of the neck and at the waist.

Benefits

The company offers a competitive base salary and benefits starting on day one. Benefits include medical and dental coverage through the organization’s own health solutions, paid time off, mental health support, retirement planning, financial protection, and professional development opportunities with clear career growth paths and learning budgets. The workplace is described as mission-driven, with diverse perspectives valued for their impact on health outcomes.

Compensation

The base pay for this role is $24 to $29 per hour, depending on location, skills, and experience. The full benefits package begins on the first day of employment.

Equal Opportunity and Safety Notice

The employer is committed to equal opportunity, diversity, equity, inclusion, and belonging. It emphasizes that it does not request payment or sensitive personal information such as social security numbers during hiring. Official communication is sent only through verified company email addresses or the secure applicant tracking system.

Additional Information

This role is based in the United States and is an onsite full-time position.

Provider Relations Specialist