Provider Relations Representative Job Description
Provider relations representative
provides support to Primary Care Providers through face to face meetings, promoting integration of behavioral health and medical care, with a spectrum of activities—from increasing knowledge of behavioral health services and establishing linkages with behavioral health providers, to establishing integration of behavioral health services into primary care practices.
Provider Relations Representative Duties & Responsibilities
To write an effective provider relations representative job description, begin by listing detailed duties, responsibilities and expectations. We have included provider relations representative job description templates that you can modify and use.
Sample responsibilities for this position include:
Maintains working knowledge of the Medicaid programs and procedures and communicates information to external provider community and internal customers
Responsible for locating and promoting potential providers to participate in Traditional Medicaid, Texas Health Steps (THSteps) , Case Management for Children and Women , Family Planning, DME Pharmacy and the Children with Special Health care Needs (CSHCN) Services Program
Recruits providers not currently enrolled in Medicaid
Visit clinical practices to understand their goals, issues, operations, organization and identify how to integrate quality metrics / gaps in care into daily workflows
Meet with key hospital, physician group, and community-based providers on a regular basis to identify problems and/or concerns
Work closely with Membership Committee on recruitment strategies for new physicians
Identify network gaps and implement recruitment strategies
Maintain provider database
Establish working relationships and collaborate with office staff in processing applications, executing contracts and credentialing providers
Work together with providers and office staff to ensure compliance with program requirements
Provider Relations Representative Qualifications
Qualifications for a job description may include education, certification, and experience.
Education for Provider Relations Representative
Typically a job would require a certain level of education.
Employers hiring for the provider relations representative job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Collage Degree in Business, Education, Healthcare, Health Care Administration, Healthcare Administration, Health Care, Health, Medical, Healthcare Management, Communication
Skills for Provider Relations Representative
Desired skills for provider relations representative include:
Financial terms
Metrics
Contracting process
Medicaid
Behavioral health provider system strongly
Public and private delivery systems in behavioral health care
Medical terminology
Various provider payment methodologies
Various quality programs
Government managed care products and terminology
Desired experience for provider relations representative includes:
Conduct outreach, education, training and orientation sessions for providers and key administrative staff
Monitor practice performance and makes recommendations for corrective action plans and other interventions as required
Perform site visits to ensure that all contractual relationships are maintained and to identify barriers
Review goals on an on-going basis with Executive team
Coordinate and participates in Beacon sponsored events which may occur outside of regular office hours
Follow all applicable federal/state regulations with respect to Confidentiality and HIPAA, among others
Provider Relations Representative Examples
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Provider Relations Representative Job Description
Job Description Example
Our company is growing rapidly and is looking to fill the role of provider relations representative. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for provider relations representative
- Support all provider relations initiatives
- Contribute to efficient and effective provider support
- Working knowledge of Strataware/Power Track, Citadel and Call Track
- Resolves issues successfully in a proactive and timely manner
- Identifies training and system deficiencies and issues
- Provides oversight on claims issues
- Proactively strategies for membership growth and retention, through advanced communication to providers, follow-up to gauge the response to that growth
- The Provider Relations Coordinator, under general supervision is responsible for maintaining provider information in internal databases and files
- Ensures the accuracy and completeness of provider data as reflected in the Health Plan directories
- Distributes information and reports
Qualifications for provider relations representative
- Submit accurate and complete initial credentialing packages
- Complete and submit required reports in a timely manner
- One or two years of experience in a medical environment dealing with managed care or insurance issues
- Previous experience in provider contracting or provider relations
- Experience with MSR, PDMS and PIMS
- Bachelor's Degree or 1 - 2 years of equivalent business, contracting, customer relations and/or TRICARE experience
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Provider Relations Representative Job Description
Job Description Example
Our innovative and growing company is looking to fill the role of provider relations representative. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for provider relations representative
- Researches and resolving inconsistent data
- Assists in taking incoming calls from providers, patients or vendors
- Supports the Customer Relations department as needed and maintains strict confidentiality
- Assure that assigned providers have current copies of all relevant educational materials, including the billing handbook and provider manual
- Work with the Director, Provider Relations and other staff as appropriate to develop the provider manuals and handbooks
- Coordinates and conducts orientations and training for newly contracted physicians and established providers to ensure the provider understands their role and responsibility
- Meets all contractual obligations while establishing positive interpersonal relations among all individuals involved within the program
- Troubleshoots problems presented by escalated provider issues
- Performs face to face visits including driving to provider offices, recruitment, Regional Advisory Council, and workshop committees
- Schedules regular provider office visits for goodwill and problem solving efforts
Qualifications for provider relations representative
- Knowledge of administering Vision insurance
- Retail Optical/ Vision industry experience
- Requires local travel to network providers
- Requires travel between client locations, to provider offices, hospitals and professional trade associations as required
- Knowledge regarding managed care and various provider reimbursement methods
- Multi-functional experiences
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Provider Relations Representative Job Description
Job Description Example
Our growing company is looking for a provider relations representative. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for provider relations representative
- Performs face to face visits driving to provider offices, recruitment, Regional Advisory Council, and workshop committees
- Reports documentation of office visits and any necessary follow up activities Handles customer requests and maintains customer satisfaction Interacts with all levels of management and clients effectively
- Initiates calls to new providers targeting specific program needs and target areas within Region Territory Number
- Promotes and recruit for THSteps Medical and Dental, CSHCN, Family Planning and other services
- Promotes and recruit providers to use web based applications such as electronic claim submission and the Provider Enrollment Portal
- Updates provider records
- Telephonic outreach targeted providers
- Email outreach and follow up to providers
- Scheduling of appointments with potential providers and the account management team
- Discussions with providers regarding the organization and participation benefits of joining the network
Qualifications for provider relations representative
- Own transportation for office and site visits (10% - 50% travel required)
- Bachelor's degree in healthcare, management, business or related field, or equivalent work experience
- 1+ year of experience related to Network Management, Provider Relations, Sales, Customer Services, or Healthcare
- Previous presentation experience with strong public speaking skills
- Ability to provide training and counseling regarding billing inquiries for the Indiana Medical Assistance Providers
- Ability to respond to inquiries by phone or written correspondence
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Provider Relations Representative Job Description
Job Description Example
Our company is growing rapidly and is looking to fill the role of provider relations representative. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for provider relations representative
- Maintaining working knowledge of the NH Medicaid Program and procedures, and able to communicate information to the external (provider community) and internal staff
- To implement technical requirements such as correct use of CPT codes for certain diagnosis and treatments
- For benchmarking data and goals
- To supply information and analysis to assist in improving quality, expense and utilization
- Provide on-site education and issue resolution from lessons learned from GPRO submissions
- Collaborate with the clinical and care coordinator teams to develop and implement training and communications tools to assist the providers in delivering a high-quality, cost-effective patient care experience
- Serve as a resource for providers to answer questions, keep them informed about policies and procedures related to Shared Savings, including CAHPs and other patient satisfaction initiatives
- Prepare and distribute informational materials and communications necessary for the development of provider relationships with our organization and collaborative partners, provide informational updates and facilitate the practice transformation process
- Participate in networking, Beacon University and other provider related events
- Follow all applicable federal/state regulations with respect to Confidentiality, HIPAA, Code of Conduct and other compliance regulations and requirements
Qualifications for provider relations representative
- Ability to respond to customer requests in a timely manner
- Ability to present formal presentations in front of large and small audiences
- Must have a clinical degree consistent with the assigned application and at least 5 years in a progressive clinical role or equivalent background with a strong understanding of the medical field
- Demonstrates compassion, empathy, listening skills, organizational skills, people skills, problem-solving skills and time-management skills
- Superior organizational skills, with a strong attention to detail and accuracy
- High level of professionalism and ability to work well with others
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Provider Relations Representative Job Description
Job Description Example
Our company is growing rapidly and is searching for experienced candidates for the position of provider relations representative. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for provider relations representative
- Provide on demand education and policy/procedural information to provider community internal/external stakeholders
- Position involves excessive traveling (75%) to provider offices
- Identify and develop potential business opportunities and new targeted customers
- Introduce and familiarize providers on all aspects of the provider manual related to services, benefits and provider requirements
- Create reports, projects, and other duties, as appropriate
- Network Development activities in new and existing markets
- Recruit non participating providers to join our networks via mailings, phone, email, fax and on-site visits
- Negotiate standard and special deal contracts to establish and maintain compliance and increase access in weak networks
- Instruct providers on the importance of submitting all credentialing documents in a timely manner with complete information
- Ensure complete credentialing packages are submitted and obtain any missing information from providers
Qualifications for provider relations representative
- Ability to prioritize and manage multiple projects and issues effectively
- Capable of public speaking and delivering presentations
- Must be able to travel locally up to 75% of the time to physicians' offices
- Bachelor's degree in Health Services, Health Care/Hospital Administration, or a related field or equivalent combination of education and experience
- Minimum three (3) years of related experience (provider relations, network management, provider customer service) in a managed care environment
- Strong PC skills in Excel, Access and SQL