Provider Relations Representative (Healthcare)

Location: Remote and field based in Illinois; must reside in Illinois, with 50% travel within Illinois. Occasional travel to hirify.global offices may be required. Working hours are Monday–Friday, 8:00 am–5:00 pm CST.

Salary: $65,200–$89,000 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare company providing insurance and healthcare services to Medicare and Medicaid members, families, individuals, military personnel, and communities.

What you will do

• Manage day-to-day relationships with assigned LTSS providers and support network retention.
• Onboard providers and conduct orientations, required annual training, policy education, and systems training.
• Respond to provider inquiries and coordinate issue resolution with claims, reimbursement, enrollment, prior authorization, and referral teams.
• Create provider trainings based on feedback, claims trends, and process changes.
• Organize provider meetings, agendas, materials, minutes, regional town halls, and trainings.
• Ensure compliance with Illinois managed care requirements for complaints, inquiries, and claims dispute resolution.

Requirements

• Must reside in Illinois and be able to travel 50% within Illinois.
• At least 2 years of healthcare or managed care experience working with providers.
• Experience with LTSS providers, skilled nursing facilities, or atypical provider types.
• Experience in provider operations, relationship management, financial or contracting arrangements, and regulatory requirements.
• Understanding of managed care contracts, contract language, and reimbursement.
• Strong critical thinking, issue resolution, presentation, facilitation, and interpersonal skills.

Nice to have

• Experience with Illinois Medicaid.
• Understanding of claims systems, adjudication, coding, submission processes, and dispute resolution.
• Knowledge of service coordination, prior authorizations, health plan processes, or value-based payment programs.

Culture & Benefits

• Remote home workstyle with hirify.global office use as needed for collaboration and face-to-face needs.
• Dedicated, interruption-free workspace required to protect member PHI and HIPAA information.
• Minimum home internet requirements of 25 Mbps download and 10 Mbps upload.
• Medical, dental, and vision coverage, 401(k), paid time off, holidays, parental and caregiver leave, disability coverage, and life insurance.
• Mileage reimbursement is provided for eligible work-related travel.