Provider Relations Representative, Sr. jobs in Delaware

Provider Relations Representative, Sr. 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. May provide guidance or expertise to less experienced representatives. Being a Provider Relations Representative, Sr. typically requires a bachelor's degree. Typically reports to a supervisor or manager. The Provider Relations Representative, Sr. gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Provider Relations Representative, Sr. typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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Provider Relations/Mailroom- DE
  • Gainwell Technologies LLC
  • Newark, DE FULL_TIME
  • Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.


    Summary

    A minimum of 1 year’s experience in a call center environment is required. Experience in health/human services and knowledge of Medicaid preferred. Complete pre and post-enrollment site visits according to customer guidelines. Provide excellent customer service primarily by telephone to Medicaid Providers. Assist providers with submission of enrollment applications which includes, appropriate taxonomies, application type, and troubleshooting application process. Follow Customer approved policy regarding submission and processing of enrollment applications. Conduct appropriate research and follow-up for prompt resolution.

    Your role in our mission

    This is an important position in Gainwell’s commitment to helping clients deliver better health and human services outcomes.

    Complete pre and post-enrollment site visits by customer policy. Accurately document the results of the site visit and maintain the record in the provider file. This position will involve travel to provider offices within 50 miles of the Delaware border. Anticipated travel is less than 50%. In addition to completing the site visits, support of the Provider Enrollment call center is expected.

    Work efficiently in a high-volume call center while maintaining a professional, polite manner. Assist callers with enrollment-related questions; accurately interpret policy, analyze customer inquiries, and determine steps for resolution. Keep resource information up to date and organized. Document calls clearly and consistently in the computer system. Conduct appropriate research and follow-up for prompt resolution of disputed enrollments. Relay information to appropriate departments and personnel using established communication channels and procedures. Must be able to type and talk at the same time and navigate through multiple screens Ability to maintain confidentiality and adhere to HIPAA requirements. At times, it may be necessary to schedule meetings with providers to assist with the enrollment process.

    Process provider enrollment applications within the SLA. Review enrollment applications against customer policy to ensure appropriate enrollment in DMAP programs. Work with the customer to review applications as outlined in the policy.

    Promptly respond to written inquiries from providers and customers regarding enrollment questions/concerns.

    What we're looking for

    • Experience working in a metric-driven work environment.
    • Experience using an auto-answer system.
    • Experience working in the Healthcare Industry
    • Experience working with Medicaid or Medicare
    • Experience meeting specific service level agreements (SLAs)
    • Experience in provider enrollment or provider credentialing
    • 2 or more years of customer service experience in any industry
    • Knowledge of basic help desk software, computer software, and Microsoft Office applications
    • Strong problem-solving skills to bring inquiries to effective resolution
    • Strong customer service skills with an emphasis on written and oral communication to respond to inquiries professionally
    • Ability to understand your role on a team and identify the correct stakeholders to consult to resolve client inquiries

    What you should expect in this role

    • Participates productively as a member of a team.
    • Completes tasks beyond the general support level.
    • Accepts instruction and direction from leadership. Ability to manage tasks and assignments without detailed direction.
    • Identifies, prioritizes, and resolves some issues independently, and escalates more complex questions or issues appropriately.
    • Complies with contract requirements, business unit rules, and related legal regulations.
    • 50% will be helping the mailroom out when needed.

    #LI-ON-SITE #LI-JW1


    The pay range for this position is $29,100.00 - $41,600.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.


    We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.


    Gainwell Technologies is committed to a diverse, equitable, and inclusive workplace. We are proud to be an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

  • 16 Days Ago

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Guest Relations Representative
  • Vogue On 54 Salon & Spa
  • Selbyville, DE FULL_TIME,PART_TIME
  • Guest Relations Position Description Division/Department: Guest Relations Reporting Relationship: Manager Job Classification: Salon & Spa Team Compensation Structure: Hourly Bonus Professional Objecti...
  • Just Posted

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Associate Relations Representative
  • Impact Solutions Inc
  • Milford, DE FULL_TIME
  • This position is responsible and accountable for establishing a working relationship with managers, supervisors and hourly production associates in the processing plant to foster an environment of coo...
  • 8 Days Ago

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Corporate Relations Representative
  • Sunday Breakfast Mission
  • Wilmington, DE FULL_TIME
  • MinistryHub is honored to partner with Sunday Breakfast Mission in their search for a Corporate Relations Representative. Please direct all applications through MinistryHub and any inquiries to hello@...
  • 1 Month Ago

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Provider Enrollment Representative
  • Gainwell Technologies
  • Newark, DE FULL_TIME
  • Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have ...
  • 15 Days Ago

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Labor Relations & Employment Practices Specialist
  • State of Delaware - DHR/Division of Labor Relations and Emp Svcs
  • Dover, DE FULL_TIME
  • Summary StatementThis is labor relations and employment practices work at the full performance level having responsibility for strategic leadership and exercising independent judgment and discretion. ...
  • Just Posted

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Guest Relations Representative
  • Great Escape
  • Queensbury, NY
  • What You Will Be Doing Assist Guests with the purchase of in park Admission and Group Sales Tickets as well as On-line T...
  • 4/26/2024 12:00:00 AM

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Donor Relations Representative
  • Christus Health
  • Irving, TX
  • Description Summary: Responsible for gift processing and donor relations including: responding to all donor inquiries, r...
  • 4/26/2024 12:00:00 AM

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Patient Relations Representative
  • Gastro Health
  • Reston, VA
  • Gastro Health is seeking a Full-Time Patient Relations Representative to join our team! Gastro Health is a great place t...
  • 4/25/2024 12:00:00 AM

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Customer Relations Representative
  • Cashdollar Insurance Agency Inc
  • North Versailles, PA
  • Job Description Job Description Are you outgoing and customer-focused? Do you enjoy working with the public? If you answ...
  • 4/25/2024 12:00:00 AM

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Customer Relations Representative
  • Metasys Technologies
  • Fort Mill, SC
  • Customer Relations Representative Fort Mill, SC (onsite) 6+Month Contract Client is seeking a Customer Support Represent...
  • 4/24/2024 12:00:00 AM

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Customer Relations Representative
  • Arete Connections
  • Lexington, KY
  • Job Description Job Description Are you a dedicated, self-driven individual with a passion for providing outstanding cus...
  • 4/24/2024 12:00:00 AM

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Guest Relations Representative
  • Six Flags Great Adventure
  • Jackson, NJ
  • Assist Guests with questions, comments, concerns they may have about their experience while visiting Six Flags. Resolve ...
  • 4/23/2024 12:00:00 AM

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Community Relations Representative
  • AmeriHealth Caritas
  • Hazleton, PA
  • Your career starts now. We are looking for the next generation of health care leaders. At AmeriHealth Caritas, we are pa...
  • 4/23/2024 12:00:00 AM

Delaware is 96 miles (154 km) long and ranges from 9 miles (14 km) to 35 miles (56 km) across, totaling 1,954 square miles (5,060 km2), making it the second-smallest state in the United States after Rhode Island. Delaware is bounded to the north by Pennsylvania; to the east by the Delaware River, Delaware Bay, New Jersey and the Atlantic Ocean; and to the west and south by Maryland. Small portions of Delaware are also situated on the eastern side of the Delaware River sharing land boundaries with New Jersey. The state of Delaware, together with the Eastern Shore counties of Maryland and two co...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Relations Representative, Sr. jobs
$72,595 to $90,028

Provider Relations Representative, Sr. in Duluth, MN
Held meetings with providers to review new policies, products and issue resolution.
January 14, 2020
Provider Relations Representative, Sr. in Norwich, CT
The continued upward spiral in health care costs has challenged sponsors, providers and payers of health benefits to deliver high quality care in the most cost-effective manner possible.
January 21, 2020
Provider Relations Representative, Sr. in Poughkeepsie, NY
The specific duties of customer service representatives vary by industry.
December 25, 2019