Provider Relations Representative (Hybrid) Position Available In Miami-Dade, Florida

Provider Relations Representative (Hybrid)

Genuine Health Group Miami, FL Summary:

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. The Provider Relations Representative role requires frequent travel throughout their assigned areas.

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. Educate providers and their staff on contractual obligations, incentive programs, and clinical best practices to drive improvements in Quality, Risk Adjustment, Growth, and Total Medicare Cost. Conduct new provider ongoing trainings on healthcare delivery models, health plan partnerships, patient care plans, and operational workflows. Maintain proactive, open lines of communication with providers to address and resolve issues related to claims, eligibility, utilization management, quality metrics, and risk adjustment programs. Monitor and communicate ongoing performance against Key Performance Indicators (KPIs), including those tied to the Genuine Rewards Program, and provide actionable insights for improvement. Collaborate with provider groups to develop, implement, and track performance improvement plans aimed at enhancing patient outcomes, financial sustainability, and care quality. Lead strategic provider meetings, including scheduling, agenda development, preparation of materials, and documentation of key discussion points and next steps. Engage cross-functionally with departments such as Quality, MRA, Case Management, Contracting, and Clinical Operations to align support efforts and drive group performance. Partner with the contracting team to ensure provider data accuracy and facilitate necessary updates. Participate in internal leadership and strategy meetings to provide insights from the field and support strategic planning. Conduct regular in-person practice visits (minimum 60% of work week) in accordance with Genuine Health’s high-touch provider engagement model. Develop and execute outreach strategies to engage high-performing specialists and ancillary providers, promoting best practices and improved referral relationships. Cultivate long-term provider partnerships through consistent communication, professional responsiveness, and a collaborative problem-solving approach. Drive measurable improvement in Stars ratings, risk score accuracy, and medical cost performance across assigned provider panels. Contribute to network-level targets in member retention, provider satisfaction, and quality improvement benchmarks. Adapt to evolving CMS requirements and organizational strategies by proactively aligning provider education and outreach initiatives. 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. 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. 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.

Job Type:

Full-time Pay:

Up to $70,000.00 per year

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Employee discount Flexible spending account Free parking Health insurance Health savings account Life insurance Paid time off Parental leave Referral program Retirement plan Tuition reimbursement Vision insurance

Schedule:

8 hour shift Monday to Friday Application Question(s): “Will you now or in the future require sponsorship for employment visa status (e.g., H-1B, O-1, TN, etc.)?” What are your salary expectations?

Education:

Bachelor’s (Preferred)

Experience:

Medicare Advantage, ACOs, or MSOs:

5 years (Required)

Provider Relations:

3 years (Required) Willingness to travel: 50% (Required)

Work Location:

On the road