Provider Relations Representative jobs in Philadelphia, PA

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
  • Community Behavioral Health.
  • Philadelphia, PA FULL_TIME
  •  

    Position Overview: 

    The Provider Relations Representative acts as the CBH primary point person to CBH’s provider network for education, support and resolution of Provider inquiries. The Provider Relations Representative primarily fosters Community Behavioral Health’s ability to support, develop and maintain a collaborative and positive relationship with the Provider Network, through excellent customer service, in order to ensure that each Provider has continued success within the CBH Provider Network.

    Essential Functions

    • Responsible for cross-collaborating with multiple departments within CBH and as the most current source of knowledge for all assigned contracted Providers and Practitioners. 
    • Responsible for maintaining a repository of information for each of their assigned providers and practitioners.
    • Oversee and maintain an assigned caseload of in-network Providers and Practitioners.
    • The Representative will serve as a primary source of support and resource for their caseload, along with providing direction and assistance in resolving any emerging concerns as the Provider’s navigate the Department of Behavioral Health and Intellectual disAbility Services (DBHIDS). 
    • Ensures that all 4 components of DBHIDs (CBH as well as OMH, OAS (CODAAP), and IDS (MRS)) are able to retrieve information upon request regarding the provider/practitioner’s  levels of care offered, locations, contact information, provider leadership, billing history, claims issues, and contract status (as needed). Delivers additional information internally as requested, by the Provider.
    • Ensures Provider Network remains aware of all DBHIDs initiatives across all 4 components that are Provider related. 
    • Conduct site visits for all assigned CBH Providers regularly, unless the Provider Relations Representative participates in alternative regularly pre-scheduled CBH meetings at the Provider Site. 
    • Obtain Provider Capacity updates quarterly. More frequent updates, upon request. 
    • Provide coverage for Provider Hotline during normal business hours, as assigned.
    • Participates in a multitude of meetings on behalf of their providers, to include but not limited to: Network Improvement and Accountability Collaborative (NIAC) prep meetings, compliance meetings, clinical provider meetings, provider teaming’s, claims and billing meetings, and executive level Provider Relations meetings with the CBH Chief Executive Officer (CEO).  
    • The Provider Relations Representative is responsible for gathering agenda items, taking meeting minutes and ensuring follow up occurs for the executive-level Provider meetings.
    • Maintain provider agency licensing, insurance and rate information.   Generate Schedule A (contract) change letters.


    Position Requirements: 

    • Education: Bachelor’s degree, preferably in a behavioral health/healthcare administration and/or business administration related field
    • License/Certification:   N/A
    • Relevant Work Experience: Minimum of 3  years of equivalent experience, preferably in the mental health field, with knowledge of managed care and Medicaid/Medicare programs
    • Skills:
    • Proficiency in Microsoft Office
    • Strong analytic and problem solving abilities 
    • Excellent verbal and written communication skills; ability to communicate with all levels of individuals
    • Excellent customer service and networking skills
    • Ability to organize and prioritize tasks
    • Ability to work as part of a team


    Covid-19 Vaccine Requirement: 

    • The safety and well-being of our candidates, our people, and their families continues to be a top priority. Subject to applicable law, please be aware that CBH requires all employees to be fully vaccinated as a condition of employment.

    U.S. Authorization Requirement: 

    • CBH does not provide sponsorship for applicants requiring future work authorization. All candidates must be legally authorized to work in the United States without requiring sponsorship now or in the future.

    Equal Employment Opportunity:  

    • We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CBH is an equal opportunity employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on all qualified individuals. This is without regard to race, ethnicity, creed, color, religion, national origin, age, sex/gender, marital status, gender identity, sexual orientation, gender identity or expression, disability, protected veteran status, genetic information or any other characteristic protected individual genetic information, or non-disqualifying physical or mental handicap or disability in each aspect of the human resources function by applicable federal, state, or local law.

    Requesting An Accommodation: 

    • CBH is committed to providing equal employment opportunities for individuals with disabilities or religious observance, including reasonable accommodation when needed. If you are hired by CBH and require an accommodation to perform the essential functions of your role, you will be asked to participate in our accommodation process. Accommodations made to facilitate the recruiting process are not a guarantee of future or continued accommodation once hired. 
    • If you would like to be considered for employment opportunities with CBH and have accommodation needs for a disability or religious observance, please send us an email at CBH.Recruitment@Phila.gov 
  • 14 Days Ago

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Provider Relations Coordinator
  • Clark Resources
  • Philadelphia, PA FULL_TIME
  • Knowledge, Skills, and Abilities Required: Position requires (a) Bachelor’s degree in Marketing, Communications, or Healthcare-related field and at least 3 years’ work experience in provider relations...
  • 1 Day Ago

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Hospice Provider Relations (Community Liaison) - Philadelphia County
  • Crossroads Hospice & Palliative Care
  • Philadelphia, PA FULL_TIME
  • The Provider Relations (Community Liaison) is a results-driven professional who supports the interdisciplinary hospice team by building relationships with doctors, facilities, and other healthcare org...
  • 25 Days Ago

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Provider Relations Specialist - Healthcare (Phila., PA)
  • MidAtlantic Employers' Association
  • Philadelphia, PA FULL_TIME
  • Job Description: Provider Relations Specialist - Phila., PA Homestead Smart Health Plans has an immediate opening for an 'experienced', organized, and detail-oriented Provider Relations Specialist. Jo...
  • 9 Days Ago

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Member Relations Representative
  • Health Partners Plans
  • Philadelphia, PA FULL_TIME
  • Why Choose Jefferson Health Plans? We are an award-winning, not-for-profit health maintenance organization. We are committed to creating a community where everyone belongs, acknowledges, and celebrate...
  • 1 Month Ago

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Member Relations Representative- Medicaid
  • Health Partners Plans
  • Philadelphia, PA FULL_TIME
  • Why Choose Jefferson Health Plans? We are an award-winning, not-for-profit health maintenance organization. We are committed to creating a community where everyone belongs, acknowledges, and celebrate...
  • 23 Days Ago

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0 Provider Relations Representative jobs found in Philadelphia, PA area

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Customer Relations Representative
  • Wendy Phung - Allstate Insurance
  • Philadelphia, PA
  • Job Description Job Description Benefits/Perks: Paid time off (vacation and/or sick days) Growth potential Salary plus c...
  • 3/28/2024 12:00:00 AM

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Direct Customer Service Representative
  • Signature, Inc.
  • Philadelphia, PA
  • Signature has been working hard this year to expand our reach with our Telecom clients. We have just opened up our locat...
  • 3/28/2024 12:00:00 AM

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Customer Service Representative Philadelphia, PA Branch Operations 02-12-2022
  • Help at Home, LLC
  • Philadelphia, PA
  • **Thanks for visiting our Career Page. Please review our open positions and apply to the positions that match your quali...
  • 3/28/2024 12:00:00 AM

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Brand Customer Care Representative Full Time | Philadelphia, PA - Philadelphia, PA, 19154 chevron_right
  • Tucci Learning Solutions, Inc.
  • Philadelphia, PA
  • Brand Customer Care Representative Job Details Job Location Philadelphia, PA - Philadelphia, PA Position Type Full Time ...
  • 3/28/2024 12:00:00 AM

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Customer Service Representative Philadelphia, PA Branch Operations 02-21-2022
  • Help at Home, LLC
  • Philadelphia, PA
  • **Thanks for visiting our Career Page. Please review our open positions and apply to the positions that match your quali...
  • 3/28/2024 12:00:00 AM

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SUPERVISORY CUSTOMER SERVICE REP (BILINGUAL SPANISH) * MSP*
  • Treasury
  • Philadelphia, PA
  • ** SUPERVISORY CUSTOMER SERVICE REP (BILINGUAL SPANISH) * MSP*** **Department of the Treasury** **Location** 1 vacancy i...
  • 3/28/2024 12:00:00 AM

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Client Relations Representative
  • RSP Events
  • Philadelphia, PA
  • Job Description Job Description We are seeking an enthusiastic and dynamic individual to join our team as a Retail Marke...
  • 3/27/2024 12:00:00 AM

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Customer Relations Representative - State Farm Agent Team Member
  • Joe Veiga - State Farm Agent
  • Levittown, PA
  • Job Description Job Description Position Overview: Are you outgoing and customer-focused? Do you enjoy working with the ...
  • 3/26/2024 12:00:00 AM

Philadelphia, sometimes known colloquially as Philly, is the largest city in the U.S. state and Commonwealth of Pennsylvania, and the sixth-most populous U.S. city, with a 2017 census-estimated population of 1,580,863. Since 1854, the city has been coterminous with Philadelphia County, the most populous county in Pennsylvania and the urban core of the eighth-largest U.S. metropolitan statistical area, with over 6 million residents as of 2017[update]. Philadelphia is also the economic and cultural anchor of the greater Delaware Valley, located along the lower Delaware and Schuylkill Rivers, wit...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative jobs
$56,715 to $72,556
Philadelphia, Pennsylvania area prices
were up 1.0% from a year ago