Fallon Health · 4 hours ago
Provider Relations Representative
Worcester, MA, US
Full-time
Onsite
Mid Level
3+ years expFallon Health is a company dedicated to providing equitable and high-quality healthcare. The Provider Relations Representative serves as the primary liaison between the company and contracted providers, ensuring compliance and resolving operational issues.
FitnessHealth CareMedical
Responsibilities
Serve as primary Fallon Health contact for providers to resolve issues relating to the administration and operation of providers' contracted services
Orient and educate primary care, specialist, hospital, and ancillary providers by conducting physician and office staff visits. Educate providers on Fallon Health policies and procedures to include products, benefits, claims, referral and eligibility verification processes, utilization management guidelines, etc. Activities include conducting both individual and large group education sessions on a continual basis
Engage necessary Fallon Health staff members and conduct investigative research to resolve provider issues. Work collaboratively with internal partners to reduce provider issues and implement long term solutions to problems identified
Escalate conflicts to Manager of Provider Relations and when appropriate Director, Provider Relations
Monitor and counsel providers on disciplinary actions and non-compliance issues
Develop and maintain positive and productive rapport with Fallon Health providers through proactive relationship management and communications
Assist in the development of provider training material and provider tools. Deliver provider training including new provider orientations, individual and/or group training on various healthcare administration topics, government compliance regulations and FCHP policies and procedures for products, benefits, claims, referral, and eligibility and utilization management
Co-lead internal and external Joint Operations Committee meetings with contract managers
30-50% Travel is required
Qualification
Required
Bachelor's degree in related discipline with healthcare administration training highly desirable
Valid Driver's License and Clean Driving Record Required
3-5 years' experience
Thorough knowledge of government regulations as dictated by regulatory agencies, including NCQA (National Committee on Quality Assurance) and CMS (Centers for Medicare & Medicaid Services)
Proficiency with desktop computer applications, Microsoft Office package and Mainframe knowledge (i.e. QNXT, IDX etc.)
Training curriculum development and platform presentation techniques
Exemplary customer relations skills
Clear and concise written and verbal communication skills
Company
Fallon Health
Founded in 1977, Fallon Health is a community-focused not-for-profit health care services organization based in Worcester, Massachusetts.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Dorothy Vandette
Manager, CEO Office
Todd Bailey
Senior Vice President, Chief Financial Officer
Recent News
2026-01-09
2025-08-07
2025-06-07
Company data provided by crunchbase