Provider Network Operations Representative

Provider Network Operations Representative

Department: Provider Relations

Employment Type: Full Time

Location: 19500 HWY 249, Suite 570 Houston, TX 77070

Reporting To: Julie Wohrlin

Compensation: $47,000 - $60,000 / year

About the Role

We are currently seeking a highly motivated Provider Network Operations Representative to support our Texas Market Provider Network Operations team. This role reports to the Sr. Manager, Provider Network Operations and is responsible for supporting the day-to-day operational activities of the provider network, including provider onboarding, maintenance, issue resolution, and compliance-related processes.

The ideal candidate is detail-oriented, customer-focused, and highly organized, with a passion for supporting providers and improving operational efficiency. This individual will serve as a key liaison between providers and internal departments, helping ensure accurate provider data, timely issue resolution, and compliance with regulatory and health plan requirements.

Our Values:

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

• Support provider network operations, including provider onboarding, terminations, demographic updates, and maintenance of provider records.
• Coordinate provider-related activities across Contracting, Credentialing, Claims, Provider Relations, and other internal teams.
• Serve as a primary point of contact for provider operational inquiries, network status questions, and administrative support needs.
• Investigate, track, and resolve provider issues related to claims, reimbursement, EDI rejections, network participation, and operational processes.
• Maintain accurate provider records, documentation, tracking logs, and operational workflows.
• Assist with provider directory validation, audits, regulatory reporting, and data accuracy initiatives.
• Compile and distribute operational reports related to provider network activities and performance.
• Collaborate with internal departments and field-based network teams to support provider onboarding, education, and operational readiness.
• Participate in process improvement initiatives designed to enhance provider experience, operational efficiency, and data quality.
• Support health plan, regulatory, and organizational compliance requirements, including audit preparation and readiness activities.

• Associate's or Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred.
• At least 2 years of experience in provider network operations, provider relations, healthcare operations, managed care, health plan administration, or a related healthcare environment.
• Experience supporting provider onboarding, provider maintenance, claims resolution, credentialing, or network operations.
• Strong organizational skills with exceptional attention to detail and accuracy.
• Excellent customer service, communication, and relationship-building skills.
• Ability to prioritize multiple tasks and meet deadlines in a fast-paced environment.
• Proficiency with Microsoft Office Suite, including Word, Excel, Outlook, and Teams.
• Ability to work independently while collaborating effectively across multiple departments.

Preferred Qualifications

• Experience working with health plans, IPAs, ACOs, MSOs, or value-based care organizations.
• Knowledge of provider data management, provider directories, claims operations, credentialing, and contracting processes.
• Experience researching and resolving provider issues related to claims, reimbursement, and network participation.
• Familiarity with CMS, DMHC, and regulatory requirements related to provider network operations.
• Experience working with provider management systems, healthcare platforms, or network databases.

You're Great for This Role If You

• Enjoy building strong relationships and serving as a trusted resource for providers.
• Have strong problem-solving skills and enjoy investigating operational issues through resolution.
• Thrive in a fast-paced environment while managing multiple priorities.
• Are highly organized and maintain strong attention to detail.
• Communicate effectively with providers, health plans, and internal stakeholders.
• Take ownership of issues and follow through to completion.
• Enjoy collaborating across teams to improve operational processes and provider experience.
• Bring a positive attitude, accountability, and a customer-focused mindset.

• Hybrid work environment based on business needs.
• Frequent use of computers, healthcare systems, provider databases, and Microsoft Office applications.
• Ability to manage multiple projects, requests, and deadlines simultaneously.
• May require occasional travel for provider meetings, training sessions, or business-related events.