Verda Healthcare · 1 month ago
Provider Relations Manager
Houston,TX,US
Full-time
Onsite
Mid Level
3+ years expVerda Healthcare, Inc. is dedicated to improving access to health and wellness services for underserved communities. The Provider Relations Manager will build and maintain relationships with Independent Physician Associations and hospitals, ensuring high-quality service and support to the provider network while driving collaboration to meet strategic objectives.
Insurance
Responsibilities
IPA & Hospital Relationship Management – Serve as primary relationship owner for assigned IPAs and hospital systems; conduct regular check-ins and ensure contract compliance and performance
Provider Onboarding & Communications – Coordinate onboarding for new IPAs and providers; ensure timely delivery of materials, orientation sessions, and operational readiness
Provider Inquiries & Support – Serve as point of escalation for provider inquiries, resolving issues in collaboration with claims, utilization management, credentialing, and other internal teams
IPA Roster Management – Oversee roster submissions, validation, and updates; ensure timely and accurate provider data reporting to meet compliance and CMS requirements
Joint Operations Committees – Organize and facilitate quarterly IPA/hospital Joint Operations Committee meetings; driving consensus on performance priorities and follow up actions
Internal Liaison – Collaborate with internal stakeholders (claims, UM, credentialing, compliance, member services, IT, and finance) to enforce contract terms and regulatory requirements, including but not limited to resolve provider issues and streamline processes. Provide high-level recommendations to enhance operational workflows and service delivery
Provider Events & Education – Plan, coordinate, and host provider meetings, trainings, and appreciation events to strengthen partnerships and improve engagement
Network Adequacy Monitoring – Review monthly IPA network adequacy reports. Work collaboratively with leadership to develop action plan for gaps in access and communicate network performance to IPAs, addressing network gaps and resolution
Reporting – Develop and maintain reporting frameworks to track progress and strategic initiatives and network performance
Growth and Development – Collaborate with Provider Network Operations leadership to identify growth opportunities, retention strategies, and outreach results
Provider Adds/Terms – Manage and process provider additions and terminations, coordinating with credentialing, contracting, and directory maintenance teams
Credentialing Support – Facilitate submission of provider credentialing applications, work with delegated Credentialing Verification Organization (CVO), and ensure adherence to NCQA/CMS standards
Qualification
Required
Bachelor's degree in healthcare administration, business, or related field (or equivalent experience)
3–5 years of experience in provider relations, network management, or healthcare operations with a Medicare health plan, IPA, or hospital system
Strong knowledge of managed care concepts, provider contracting, Medicare/MAPD, and healthcare delivery systems
Experience with provider rosters, credentialing, and regulatory compliance (CMS, NCQA)
Proficiency with Microsoft Office Suite (Excel, PowerPoint, Word); ability to analyze data and prepare presentations
Ability to develop and maintain trusted partnerships with IPAs, hospitals, and provider groups
Strong written and verbal communication, including presenting to large groups and facilitating meetings
Skilled at identifying issues, analyzing root causes, and collaborating on timely resolutions
Able to navigate cross-functional teams and balance provider needs with organizational priorities
Ensures accuracy in roster management, reporting, and compliance-driven processes
Capable of planning, coordinating, and executing multiple provider initiatives simultaneously
Committed to improving provider experience while supporting organizational objectives
Benefits
401(k)
Paid time off (vacation, holiday, sick leave)
Health insurance
Dental Insurance
Vision insurance
Life insurance
Company
Verda Healthcare
VERDA Healthcare is a new Medicare Advantage Plan launched by a passionate, purpose-driven group of experienced healthcare professionals committed to the idea that healthcare should be easily and equitably accessed by all.
11-50 employees
Funding
Current Stage
Early StageLeadership Team
James Kim
Board Member, Co-Founder and Interim CMO
Thinh Tran, MD, MBA
Co-Founder and Board Member
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