Group 1001
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Provider Relations Coordinator
role at
Group 1001
Company Overview Clear Spring Health is part of Group 1001, a customer‑centric insurance group whose mission is to make insurance more useful, intuitive, and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well‐being by providing Medicare Advantage plans and Medicare Prescription Drug Plans across the United States.
Why This Role Matters The Provider Relations Coordinator plays a vital role in supporting Clear Spring Health’s network management operations by monitoring and triaging incoming communications, voicemail messages, and email inquiries from providers. The position ensures that all provider requests are accurately logged, prioritized, and routed to the appropriate internal team for timely resolution. The Coordinator is often the first point of contact, representing the company’s commitment to prompt, professional, and accurate support.
How You’ll Contribute Provider Engagement & Relationship Management
Serve as the primary contact for contracted physicians, hospitals, and ancillary providers within assigned territories.
Educate providers on Clear Spring Health policies, procedures, and Medicare Advantage regulatory requirements.
Conduct regular outreach (telephonic, virtual, or onsite) to strengthen provider engagement and satisfaction.
Support provider onboarding by ensuring credentialing, contracting, and directory data are accurate and up to date.
Issue Resolution & Support
Respond promptly to provider inquiries related to claims, authorizations, eligibility, and payment accuracy.
Coordinate with internal departments and/or TPA to research and resolve provider issues.
Track and trend provider concerns to identify opportunities for process improvement.
Escalate systemic issues to leadership for corrective action and process redesign.
Education & Training
Conduct provider orientations and ongoing education sessions on Clear Spring Health systems, portals, and resources.
Ensure providers understand CMS regulations impacting MA plans, including access standards, documentation expectations, and compliance obligations.
Distribute communications and updates regarding policy changes, coding guidance, and operational enhancements.
Performance Monitoring
Collaborate internally to monitor provider performance metrics such as claims turnaround, encounter submission, HEDIS gap closure, and member satisfaction.
Support provider scorecard initiatives.
Work with the Quality team to improve provider performance on key CMS Star measures.
What We’re Looking For
Associate’s degree in Business, Healthcare Administration, or related field preferred (or equivalent work experience).
2–3 years of experience in a healthcare administrative, provider relations, or managed care operations role (Medicare Advantage experience preferred).
Strong working knowledge of provider operations, including claims, credentialing, contracting, and prior authorization processes.
Proficient in Microsoft Outlook, Excel, and Jira (or other ticketing/workflow systems).
Excellent verbal and written communication skills with a high level of professionalism.
Strong organizational and multitasking ability with a focus on accuracy and timeliness.
Compensation The base pay for this position ranges from $50,000/year to $55,000/year in our highest geographic market. Pay is based on factors such as market location, job‑related skills, and experience.
Benefits Highlights Employees who meet benefit eligibility guidelines and work 30 hours or more weekly have the ability to enroll in Group 1001’s benefits package. Benefits include comprehensive health, dental, and vision insurance, life insurance, disability coverage, an Employee Assistance Program, wellness programs, and a 401K plan with company matching contributions.
Group 1001, and its affiliated companies, is strongly committed to providing a supportive work environment where employee differences are valued. Diversity is an essential ingredient in making Group 1001 a welcoming place to work and is fundamental in building a high‑performance team. All employees share the responsibility for maintaining a workplace culture of dignity, respect, and appreciation of individual and group differences.
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Provider Relations Coordinator
role at
Group 1001
Company Overview Clear Spring Health is part of Group 1001, a customer‑centric insurance group whose mission is to make insurance more useful, intuitive, and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well‐being by providing Medicare Advantage plans and Medicare Prescription Drug Plans across the United States.
Why This Role Matters The Provider Relations Coordinator plays a vital role in supporting Clear Spring Health’s network management operations by monitoring and triaging incoming communications, voicemail messages, and email inquiries from providers. The position ensures that all provider requests are accurately logged, prioritized, and routed to the appropriate internal team for timely resolution. The Coordinator is often the first point of contact, representing the company’s commitment to prompt, professional, and accurate support.
How You’ll Contribute Provider Engagement & Relationship Management
Serve as the primary contact for contracted physicians, hospitals, and ancillary providers within assigned territories.
Educate providers on Clear Spring Health policies, procedures, and Medicare Advantage regulatory requirements.
Conduct regular outreach (telephonic, virtual, or onsite) to strengthen provider engagement and satisfaction.
Support provider onboarding by ensuring credentialing, contracting, and directory data are accurate and up to date.
Issue Resolution & Support
Respond promptly to provider inquiries related to claims, authorizations, eligibility, and payment accuracy.
Coordinate with internal departments and/or TPA to research and resolve provider issues.
Track and trend provider concerns to identify opportunities for process improvement.
Escalate systemic issues to leadership for corrective action and process redesign.
Education & Training
Conduct provider orientations and ongoing education sessions on Clear Spring Health systems, portals, and resources.
Ensure providers understand CMS regulations impacting MA plans, including access standards, documentation expectations, and compliance obligations.
Distribute communications and updates regarding policy changes, coding guidance, and operational enhancements.
Performance Monitoring
Collaborate internally to monitor provider performance metrics such as claims turnaround, encounter submission, HEDIS gap closure, and member satisfaction.
Support provider scorecard initiatives.
Work with the Quality team to improve provider performance on key CMS Star measures.
What We’re Looking For
Associate’s degree in Business, Healthcare Administration, or related field preferred (or equivalent work experience).
2–3 years of experience in a healthcare administrative, provider relations, or managed care operations role (Medicare Advantage experience preferred).
Strong working knowledge of provider operations, including claims, credentialing, contracting, and prior authorization processes.
Proficient in Microsoft Outlook, Excel, and Jira (or other ticketing/workflow systems).
Excellent verbal and written communication skills with a high level of professionalism.
Strong organizational and multitasking ability with a focus on accuracy and timeliness.
Compensation The base pay for this position ranges from $50,000/year to $55,000/year in our highest geographic market. Pay is based on factors such as market location, job‑related skills, and experience.
Benefits Highlights Employees who meet benefit eligibility guidelines and work 30 hours or more weekly have the ability to enroll in Group 1001’s benefits package. Benefits include comprehensive health, dental, and vision insurance, life insurance, disability coverage, an Employee Assistance Program, wellness programs, and a 401K plan with company matching contributions.
Group 1001, and its affiliated companies, is strongly committed to providing a supportive work environment where employee differences are valued. Diversity is an essential ingredient in making Group 1001 a welcoming place to work and is fundamental in building a high‑performance team. All employees share the responsibility for maintaining a workplace culture of dignity, respect, and appreciation of individual and group differences.
#J-18808-Ljbffr