Provider Relations Specialist

Role Overview

The Provider Relations Specialist serves as a key liaison between healthcare providers and the Workers' Compensation Payment Integrity Department. This position is responsible for supporting provider engagement, resolving reimbursement inquiries, facilitating provider education, and assisting with dispute resolution activities. The Specialist works collaboratively with internal teams to ensure accurate reimbursement outcomes while maintaining positive provider relationships and supporting organizational payment integrity objectives. The role requires strong knowledge of workers' compensation reimbursement methodologies, provider billing practices, and payment integrity processes, as well as exceptional communication and problem-solving skills.

Role Responsibilities

Provider Support and Relationship Management

• Serve as a primary point of contact for healthcare providers regarding reimbursement inquiries, billing questions, and payment-related concerns
• Develop and maintain productive working relationships with hospitals, physician offices, ambulatory surgery centers, and ancillary providers
• Respond to provider inquiries in a timely, professional, and customer-focused manner

Reimbursement and Dispute Resolution

• Research and resolve provider questions related to bill review determinations, payment calculations, reductions, and reimbursement methodologies
• Assist in the resolution of provider disputes, appeals, reconsideration requests, and escalated reimbursement issues
• Communicate payment determination rationale to providers in a clear and professional manner
• Coordinate with bill review, coding, clinical, legal, and operations teams to facilitate issue resolution

Regulatory Compliance

• Maintain knowledge of applicable workers' compensation regulations, fee schedules, and reimbursement requirements
• Ensure provider communications are consistent with regulatory requirements and organizational policies
• Support internal compliance initiatives and audit activities as requested

Operational Support

• Document provider interactions, inquiries, and resolutions within designated systems
• Maintain accurate records of provider disputes, escalations, and communication activities
• Participate in process improvement initiatives designed to enhance provider experience and operational efficiency

Role Qualifications

• Associate's or Bachelor's degree in Healthcare Administration, Business Administration, Finance, Nursing, or a related field preferred
• Equivalent work experience may be substituted for formal education
• 2 to 5 years of experience in workers' compensation, healthcare reimbursement, provider relations, medical billing, claim operations, payment integrity, or bill review
• Experience interacting with healthcare providers and resolving reimbursement-related issues preferred
• Strong customer service and relationship management skills
• Excellent verbal and written communication abilities
• Effective conflict resolution and problem-solving skills
• Strong attention to detail and analytical capabilities
• Ability to manage multiple priorities and meet deadlines
• Ability to communicate complex reimbursement concepts clearly and professionally
• Microsoft Office Suite, including Excel, Word, Outlook, and Teams
• Claims management, bill review, or reimbursement platforms
• Experience with provider databases and reporting systems preferred
• Relationship Building
• Customer Service Excellence
• Conflict Resolution
• Communication Skills
• Accountability
• Regulatory Compliance
• Team Collaboration
• Attention to Detail

Culture and Benefits at Carisk:

• 10 Paid Company Holidays
• Paid Time Off
• Competitive Medical, Dental, and Vision Insurance
• Company Sponsored Life Insurance
• Supplemental Life Insurance, Short/Long Term Disability, Employee Assistance Program, Flexible Spending Account, and many other Ancillary Benefits
• 401(k) Retirement Plan with Company Match
• ClassPass Wellness Program
• Employee Discount Program
• Flexible and Hybrid Schedule Options*
• Internal Education Programs and Tuition Reimbursement Options
• Internal Advancement Opportunities
• Company-Wide Diversity and Holiday Celebrations
• Best Places to Work Award Recipient 5 years in a row!

*Schedule options and work location vary between departments and management approval

Carisk Partners provides equal employment opportunities to all employees and applicants for employment, and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.