Provider Relations Specialist Jobs

Position Summary

The Provider Relations Specialist will manage payer/agency network by developing and maintaining relationships to drive business results with all new and targeted existing accounts. Provide service and education to payers/agencies and internal departments. Achieve company targets through implementation of Partner Improvement plans.

Position Responsibilities may include, but not limited to

• Monitor and support providers using analytics available to improve and maintain relationships
• Achieve frequency goals to establish consistent and strong relationship with key partners
• Assist in continual training to assigned providers on best practices and other resources to assist with claims, authorizations, member benefits, etc.
• Prepare for and provide actionable discussion topics on how to gain efficiencies with key partner agencies regarding client referral and/or billing processes
• Through data or direction identify potential “problem” partner and communicate possible changes in process that would make partner relationships more efficient for both parties
• Provide oversight on claims or intake issues; follow up with providers accordingly
• Maintain company data integrity including monitoring our provider profile, name, location additions, demographic updates, etc.
• Perform special projects as assigned
• Assist in new provider orientation for all applicable product lines on behalf of client services and revenue cycle

Required Skills and Experience

• Solid initiative to improve processes and increase relationships with healthcare partners
• 1 year experience in a Provider Relations, Account Management, Healthcare Administration or relevant position with demonstrated ability to perform the duties of the position
• Bachelor’s Degree in a related field
• Strong Microsoft Office skills
• Ability to think outside the box and offer new suggestions for integrating new procedures
• Ability to build relationships and serve as a liaison between departments (claims, contracts, etc.)
• Strong organizational skills to coordinate new partnerships and keep processes moving
• Strong communication skills and ability to use appropriate tact and finesse when dealing with delicate issues

Preferred Skills and Experience

• Experience working in a healthcare, provider or HMO/PPO environment familiar with billing claims and authorization processes
• Bilingual (English/Spanish)