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The Provider Network Representative is the frontline liaison between the World Trade Center Health Program (WTCHP) and participating healthcare delivery organizations.
The role is responsible for provider onboarding, education, issue resolution, relationship management, provider engagement and satisfaction, and coordination of operational support activities. The Representative partners with Provider Data, Credentialing, Contracting, Claims, Finance, Clinical Operations, Communications, and IT to deliver consistent, high‑quality provider experience and ensure operational excellence.
Key Outcomes & Success Metrics
- Provider satisfaction & FCR: Achieve targeted satisfaction scores and first‑contact resolution rates; reduce escalations and repeat issues.
- Onboarding timeliness: Meet/exceed SLAs for onboarding and participation activation; shorten cycle times and eliminate avoidable delays.
- Issue resolution performance: Decrease average issue aging and backlog across claims, credentialing, enrollment, provider data, contracts, and portal support.
- Portal adoption & engagement: Increase portal registration, use of self‑service features, EFT enrollment, and training attendance.
- Communication effectiveness: Improve responsiveness and clarity of provider communications, job aids, and training materials.
- Quality & compliance: Maintain audit‑ready documentation; sustain SLA compliance and quality scores.
Essential Duties & Responsibilities
Relationship Management & Account Ownership
- Serve as the primary point of contact for assigned providers; conduct regular touchpoints and executive‑level check‑ins/QBRs as needed.
- Track provider sentiment and satisfaction; identify themes and drive action plans with the Provider Network Supervisor.
- Document all interactions, decisions, and follow‑ups in CRM/case management tools with clear, accurate notes.
Onboarding & Orientation
- Coordinate end‑to‑end onboarding: welcome materials, portal registration, EFT setup, credentialing handoffs, and directory validation.
- Standardize checklists, timelines, and handoffs with Credentialing, Provider Data, and Contracting to ensure accurate participation activation.
- Monitor onboarding milestones and proactively remove blockers; communicate status and next steps to providers.
Education, Training & Communications
- Deliver provider training (webinars, welcome packets, job aids) on program policies, billing requirements, and operational procedures.
- Tailor content to provider segments and roles; measure adoption and comprehension via attendance, feedback, and follow‑up assessments.
- Maintain a current library of FAQs, guides, and reference materials aligned to process changes.
Issue Intake, Escalation & Resolution
- Resolve escalated provider issues related to claims, credentialing, EFT, enrollment, and portal access; triage and route effectively.
- Follow defined escalation pathways; communicate resolution status, root cause, and prevention actions to providers and internal teams.
- Perform root‑cause analysis for recurring issues and propose corrective actions; track remediation to closure.
Portal, EFT & Self‑Service Enablement
- Promote portal features and self‑service workflows; assist with registration, user management, navigation, and troubleshooting.
- Increase EFT adoption and ensure accurate banking/EFT data in coordination with Provider Data and Claims; support verification and updates.
Cross‑Functional Collaboration
- Partner with Provider Data, Credentialing, Contracting, Claims, Finance, Clinical Operations, Communications, and IT to resolve issues and improve processes.
- Represent provider needs in workgroups; drive action items to completion and report measurable outcomes.
Reporting, Analytics & Continuous Improvement
- Maintain dashboards/logs for satisfaction, first‑contact resolution, onboarding timeliness, case aging, portal adoption, and SLA compliance.
- Analyze trends to prioritize outreach, training topics, and process enhancements; share insights in huddles and business reviews.
- Contribute to continuous improvement initiatives (templates, scripts, automation) to reduce cycle time and error rates.
Compliance, Policy & Documentation Standards
- Ensure adherence to organizational policies and applicable regulations; maintain audit‑ready documentation and records.
- Safeguard provider information (privacy/security); support audits and corrective action plans.
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