Director of Provider Relations - Bill Review

Vālenz^® Health is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible.
 

About This Opportunity:
As the Director, Provider Relations – Bill Review, you will lead a team of Provider Account Managers focused on resolving billing discrepancies identified during the coding and clinical claim review process. You will play a key role in negotiating provider claims, navigating escalated issues, and ensuring compliance with CMS and Medicare Advantage billing standards. This position is ideal for a confident leader with in-depth knowledge of claims negotiation and regulatory frameworks who thrives in a fast-paced, mission-driven environment.

Things You’ll Do Here:

• Lead, coach, and support a team of Provider Account Managers, establishing clear goals, KPIs, and development plans.
• Oversee daily operations for provider account management, ensuring timely and effective responses to provider inquiries and disputes.
• Act as the primary escalation point for complex, high-value, or sensitive provider negotiations.
• Personally manage strategic claim-level negotiations when necessary, ensuring adherence to CMS, payer, and client-specific guidelines.
• Provide hands-on guidance to the team on negotiation strategies, documentation standards, and messaging.
• Ensure provider communications align with Medicare Advantage billing policies, payer contracts, and regulatory requirements.
• Collaborate cross-functionally with Clinical Review, Coding, Client Services, and other internal stakeholders to resolve issues and streamline processes.
• Conduct regular team meetings, 1:1s, and performance reviews to support accountability and professional growth.
• Identify recurring issues and work with Quality, Compliance, and Operations to implement systemic improvements.
• Develop provider education materials to promote claim accuracy, reduce disputes, and build provider relationships.
• Monitor, analyze, and report on team performance metrics including success rate, resolution cycle time, and provider satisfaction.
• Maintain thorough, audit-ready documentation and ensure adherence to all communication protocols.
• Stay informed on CMS billing updates, industry trends, and best practices in provider relations and Medicare Advantage reimbursement.
• Perform other duties as assigned.

Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.

What You’ll Bring to the Team:

• 5+ years of experience in provider relations, claims negotiation, billing dispute resolution, or payment integrity.
• 2+ years of experience in people management or team leadership.
• Experience in itemized bill review and payment integrity, including audit techniques and revenue opportunity identification.
• Deep familiarity with Medicare Advantage billing and reimbursement rules, CMS guidelines, and provider contract structures.
• Strong working knowledge of medical coding (CPT, HCPCS, ICD-10), payment methodologies (DRG, APC), and clinical documentation standards.
• Excellent interpersonal and negotiation skills, with a track record of de-escalating high-tension conversations and building collaborative provider relationships.
• Proficiency in Microsoft Office and claims management platforms such as Facets, HealthEdge, or MedReview.

A plus if you have:

• Experience working within or with third-party administrators (TPAs) or managed care organizations.
• Professional certifications in billing, coding, or negotiation (e.g., AAPC, AHIMA, NAMSS) 

Where You’ll Work: This is a fully remote position, and we’ll provide all the necessary equipment!

• Work Environment: You’ll need a quiet workspace that is free from distractions.
• Technology: Reliable internet connection—if you can use streaming services, you’re good to go!
• Security: Adherence to company security protocols, including the use of VPNs, secure passwords, and company-approved devices/software.
• Location: You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA.

Why You'll Love Working Here

Valenz is proud to be recognized by Inc. 5000 as one of America’s fastest-growing private companies. Our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. With this commitment, you’ll find an engaged culture – one that stands strong, vigorous, and healthy in all we do.

Benefits

• Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card.
• Spending account options: HSA, FSA, and DCFSA
• 401K with company match and immediate vesting
• Flexible working environment
• Generous Paid Time Off to include vacation, sick leave, and paid holidays
• Employee Assistance Program that includes professional counseling, referrals, and additional services
• Paid maternity and paternity leave
• Pet insurance
• Employee discounts on phone plans, car rentals and computers
• Community giveback opportunities, including paid time off for philanthropic endeavors

At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.