Provider Relations Representative

Our Client, a Health Insurance company, is looking for a Provider Relations Representative for their Remote location.

Responsibilities:

• This role responsible for developing and maintaining positive constituent relationships with providers, operational departments, health institutions and other entities, handling escalated issue management and dispute resolution activities. Serves a primary liaison to provide communication, education, issue resolution and support to network providers.
• % Partners with Provider Training and Education Department to educate providers ensuring they are engaged in the value of our programs in support of positive member interactions. Provide ongoing and targeted basic training and education to our provider community ensuring they can successfully utilize electronic tools, navigate provider portal, follow processes and procedures.
• % Involved in supporting one or more health systems, representing multiple practices, enabling the organization to provide Tier One Service.
• % Provide research, analytic and resolution support for less complex special projects.
• % Provide research, analytic and resolution support on special cases and projects ensuring that all policies and contractual guidelines are clearly identified as required by the case. Provide verbal or written responses to inquiries to management and other internal and external customers. Acts as a resource and provides needed assistance to providers in resolving escalated service-related issues and timely response to provider inquiries via face to face visit, correspondence, e-mail, phone, etc.
• % Build and maintain appropriate relationship with providers by ensuring regular communications and timely problem resolution. Leverages provider relationships to drive and influence provider behavior towards favorable outcomes
• % Proactively identifies provider needs and responds appropriately through problem solving, engagement of other internal or external resources, and providing high level service

Requirements:

• High School Diploma
• years experience in the health care industry, including experience working experience with providers, training, claims, customer service and presentations.
• Bachelor's Degree in business, healthcare administration or related industry
• Previous experience with client BlueCross BlueShield, an insurance plan, a hospital, or a physician hospital organization (PHO).
• Working knowledge of provider billing and coding mechanisms., Proficient
• Thorough knowledge of managed care industry legislated and regulated requirements, health care financial matters and third-party payment methodologies., Proficient
• Understanding of contractual documents and ability to effectively communicate terms to providers., Proficient
• Working knowledge of Microsoft Excel, Microsoft Access, Microsoft PowerPoint and Microsoft Word., Proficient
• The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on Federal health care programs. Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Why Should You Apply?

• Excellent growth and advancement opportunities