Provider Relations Representative jobs in the United States

Provider Relations Representative supports, develops and maintains service relationships with all participants (physicians, providers and administrators) of a provider network. Responds to electronic and direct inquiries from clients about policies, rates, changes, referrals, eligibility, credentialing, etc. Typically requires a bachelor's degree. Being a Provider Relations Representative typically reports to a supervisor or manager. The Provider Relations Representative works on projects/matters of limited complexity in a support role. Work is closely managed. To be a Provider Relations Representative typically requires 0-2 years of related experience. (Copyright 2024 Salary.com)

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Provider Relations Representative
  • UHS
  • LAS VEGAS, NV FULL_TIME
  • Responsibilities

    Job Summary: Provider Relations Representative is responsible for assisting in the full range of provider relations and service interactions for all lines of business within Prominence Health Plan. Will assist in the design and implementation of programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Supports those who direct and implement strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs, and may also be involved in identifying and remediating operational short-falls and researching and remediating claims; and is responsible for steerage initiatives, site visits, training, educating, and overall communications including portals, webpages, letters, and email messages. Responsible for the oversight and management of Medicare Quality Reporting during each performance year and through the annual reporting periods and ensures resources are in place to complete the annual GPRO reporting requirement.


    Qualifications

    Qualifications and Requirements:

    • BS, Bus Admin, Finance or similar field, or equivalent work history
    • 2 years in HEDIS, ACO, or Care Gap reporting
    • 2 years working with Medicare contracts and regulatory reporting requirements
    • 3 years in managed care or medical insurance.
    • 2 years working in a clinical setting.
    • 1 year in a claims, customer service or provider support role.
    • Excellent oral and written English communication skills including telephone etiquette.
    • Superior interpersonal skills
    • Proficient research, critical-thinking and analytical problem-solving skills
    • Intermediate proficiency with Microsoft Office (Excel, Word, PowerPoint, Outlook).
    • Self-starter and resourceful with ability to execute projects in a fluid and fast paced environment
    • Strong organizational, planning and attention to detail skills.
    • Valid Driver’s License, reliable transportation, and proof of insurance required
    • Requires local travel and occasional out of area overnight travel required.

     

     

    EEO Statement

    All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

     

    We believe that diversity and inclusion among our teammates is critical to our success.

     

    Notice

    At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries.  We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.

  • 19 Days Ago

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Provider Relations Representative
  • American Health Plans LLC
  • Baton Rouge, LA FULL_TIME
  • American Health Plans manages institutional special needs plans (I-SNPs) in nursing homes in several states by sharing plan ownership with the facilities. Our roots in managed care run deep. We owned ...
  • 19 Days Ago

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Provider Relations Representative
  • Tarzana Treatment Centers, Inc
  • Long Beach, CA FULL_TIME
  • Full-time Provider Relations Representative available for Long Beach and Antelope Valley locations. 8 hours per day/5 days per week. This position is responsible for marketing and referral development...
  • 23 Days Ago

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Senior Provider Relations Representative
  • University Health System- San Antonio
  • San Antonio, TX FULL_TIME
  • POSITION SUMMARY/RESPONSIBILITIES Working with Department management, evaluates, plans, develops and maintains HMO network of primary care physicians/groups including RHCs, FQHCs,PHOs, IPAs and/or mul...
  • 24 Days Ago

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Provider Relations Representative
  • Desert Oasis Healthcare
  • Palm Springs, CA FULL_TIME
  • The Provider Relations Representative assists the Manger of Provider Relations and Desert Oasis Healthcare Administration by serving as a liaison between DOHC and Primary Care, Specialist Provider, th...
  • 1 Day Ago

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Provider Relations Representative
  • Tarzana Treatment Centers, Inc
  • Long Beach, CA FULL_TIME
  • Full-time Provider Relations Representative available for Long Beach and Antelope Valley locations. 8 hours per day/5 days per week. This position is responsible for marketing and referral development...
  • 2 Days Ago

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Sr. Field Service Representative - Power/Electrical
  • Schneider Electric
  • Leesburg, VA
  • Great people make Schneider Electric a great company. Schneider's Power Services Field Service Representatives play an i...
  • 3/29/2024 12:00:00 AM

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Government Account Representative
  • Carahsoft
  • Reston, VA
  • To keep step with our rapid growth in technology market, we are in search of collaborative, driven and forward-thinking ...
  • 3/28/2024 12:00:00 AM

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Customer Success Associate
  • Tyler Technologies
  • Herndon, VA
  • Description Our Implementation Consultant must be curious about how organizations work and seek to understand why people...
  • 3/28/2024 12:00:00 AM

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Call Center Sales Manager
  • Homespire Mortgage Corp.
  • Gaithersburg, MD
  • **Call Center Sales Manager** by | Feb 7, 2022 **Call Center Sales Manager** **Position Responsibilities** * Provide lea...
  • 3/28/2024 12:00:00 AM

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Field Service Representative
  • United Corporate Housing LLC
  • Reston, VA
  • Job Description Job Description Position Summary The Field Service Representative is dedicated to monitoring our core in...
  • 3/27/2024 12:00:00 AM

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T-Mobile Neighborhood Retailer Sales Associate
  • GP Mobile
  • Sterling, VA
  • Chase #LimitlessPotential at GP Mobile, an Authorized T-Mobile Retailer! GP Mobile, is one of the largest Authorized T-M...
  • 3/27/2024 12:00:00 AM

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Customer Services Representative
  • Smart Choice Cleaning, Inc.
  • Chantilly, VA
  • Job Description Job Description MUST BE BI-LINGUAL IN SPANISH !!!! Smart Choice Cleaning - Chantilly, VA Smart Choice is...
  • 3/26/2024 12:00:00 AM

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Customer Service Representative Insurance (Part-Time)
  • McCarthy Insurance Agency
  • Chantilly, VA
  • Job Description Job Description We are seeking a Part-Time Customer Service Representative Insurance to become a part of...
  • 3/26/2024 12:00:00 AM

Income Estimation for Provider Relations Representative jobs
$53,444 to $68,371