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Provider Relations Manager Jobs

Provider Relations Representative - Remote | Wfh
By Get It Recruit - Healthcare At San Antonio, TX, United States

We are seeking a Provider Relations Representative (PR Rep) to join our dynamic team. As a PR Rep, you will play a pivotal role in managing our assigned Provider Network, forging strong partnerships ...

Senior Provider Relations Representative
By BlueCross BlueShield of South Carolina At United States
Produces/generates various reports to management and provides feedback on activities to management.
Bachelor's degree OR Four (4) years of job-related work experience OR Four (4) years combined job related education and experience.
Four (4) years of experience in customer service, claims processing, communications, education/training, provider relations, healthcare or combination. (Can be concurrent)
Develops/prepares/reviews/updates all provider education materials.
Performs administrative functions in support of education and training.
Demonstrated skills related to training materials development.
Provider Relations Representative Opening For Central Phoenix Market
By Southwest Medical Imaging, LTD At Scottsdale, AZ, United States
Consistently demonstrates competency and leadership through effective management of territory by utilizing individual business plan. Referral Volume Data
Demonstrate competency in correctly entering appropriate data each month to update individual plan. Visit Planning
Utilize rolling computer bags, organization of vehicle trunk Community Marketing Presentation Efforts Health Fairs/Special Events
Provider Relations Professional - Bh
By Humana At ,
Exceptional written and verbal communication and relationship management skills
Ensure compliance with Louisiana's managed care contractual requirements for provider relations, such as claims dispute resolution within specified timeframes
Proven working knowledge of Behavioral Health provider operations, competitor strategies, financial/contracting arrangements, and/or regulatory requirements
Develop and maintain Behavioral Health provider relationships to optimize provider experience and satisfaction
Experience working with behavioral health providers and substance use providers
Understanding of behavioral health managed care and how services are delivered
Provider Relations Manager Jobs
By DynamiCare Health At Pittsburgh, PA, United States
Prepare and maintain up-to-date enrollment workflows consistent with requirements of specific implementations.
Pull and distribute monthly reporting per requirements of individual provider contracts.
An active Counseling License (OMSAS) or Substance Use Disorder Certification (Pennsylvania Certification Board) is strongly preferred.
Previous experience (2+ years) working in the SUD (addictions) profession
Knowledge of substance use disorders; if in recovery, at least 2 years of sustained recovery
Excellent oral and written communication skills, organizational skills, and high attention to detail
Provider Relations Specialist Jobs
By Mom's Meals At Ankeny, IA, United States
Assist in continual training to assigned providers on best practices and other resources to assist with claims, authorizations, member benefits, etc.
Strong communication skills and ability to use appropriate tact and finesse when dealing with delicate issues
Strong organizational skills to coordinate new partnerships and keep processes moving
Ability to think outside the box and offer new suggestions for integrating new procedures
Experience working in a healthcare, provider or HMO/PPO environment familiar with billing claims and authorization processes
Position Responsibilities may include, but not limited to
Provider Relations Manager Jobs
By CareMax, Inc. At Brockton, MA, United States
Proactive, analytical relationship management expert
Strong organizational and planning skills to manage multiple priorities and meet required deadlines
Access to continual education through CareMax University
Experience working with VBCs (value based contracts)
Minimum of three (3)– years of provider network operational experience
Strong analytical, critical thinking and problem solving skills to ensure process improvement and projects are completed successfully
Provider Relations Specialist Jobs
By Insight Global At Springfield, Massachusetts Metropolitan Area, United States
Detailed orientated problem solver with excellent time management skills and ability to meet filing due dates
Associates Degree in Health Administration, Business Administration, Regulatory Science or an equivalent combination of education and work experience in related field.
Two to three years of experience working in health insurance and regulatory industry
Strong writing, communication and interpersonal skills
Health insurance industry experience preferred
Participate in oversight calls with PPO Networks and vendors to coordinate regulatory compliance and document meeting minutes that meet regulatory guidance.
Provider Relations Representative Jobs
By Fallon Health At Worcester, MA, United States
Develop and maintain positive and productive rapport with Fallon Health providers through proactive relationship management and communications.
Escalate conflicts to Manager of Provider Relations and when appropriate Director, Provider Relations.
Co-lead internal and external Joint Operations Committee meetings with contract managers.
Proficiency with desktop computer applications, Microsoft Office package and Mainframe knowledge (i.e. QNXT, IDX etc.)
Clear and concise written and verbal communication skills
Serve as primary Fallon Health contact for providers to resolve issues relating to the administration and operation of providers' contracted services.
Provider Relations Associate Jobs
By CareMax, Inc. At Orlando, FL, United States
Proactive, analytical relationship management expert
Strong organizational and planning skills to manage multiple priorities and meet required deadlines
Access to continual education through CareMax University
Experience working with VBCs (value based contracts)
Minimum of three (3) – years of provider network operational experience
Strong analytical, critical thinking and problem solving skills to ensure process improvement and projects are completed successfully
Director, Network Management (Provider Relations) (Director Ii)
By CalOptima At Orange, CA, United States
Bachelor’s degree in Health Care Management or a related field required.
5 years of progressive leadership experience, including direct supervision of staff, in managed care, providers or health plans required.
Medicaid managed care, Medicare risk-contract, or commercial Health Maintenance Organization (HMO) insurance experience required.
Master’s degree in Health Care Management or related field.
Medi-Cal managed care plan experience or related government client or public sector experience.
Directs training of providers to promote cost-effective managed care, compliance, and enhancement of service standards.
Provider Relations Specialist Jobs
By Mindlance At United States
100% Remote/ Work from Home
·The main purpose of this role is to reschedule all canceled appointments either by patient are provider.
·Strategize, coordinate, create and execute Provider schedules efficiently and effectively.
·The Candidate must be comfortable making 200+ outbound calls a day and working in an independent environment.
·Reschedule all appointments canceled either by patient are provider.
·Establish concierge level relationships with assigned providers.
Provider Relations Manager Jobs
By Connect Chiropractic At Wauwatosa, WI, United States
Requirements For a Provider Relations Manager
Experience in marketing, sales, or networking
OUR IDEAL PROVIDER RELATIONS MANAGER
Public Speaking Abilities Are Preferred.
Customer service driven - Eager to help customers find solutions regardless of challenges
Respectful - Treats others with kindness and is positive and helpful
Director Of Provider Relations
By DynamiCare Health At Massachusetts, United States
Prepare and maintain up-to-date enrollment workflows consistent with requirements of specific implementations.
Pull and distribute monthly reporting per requirements of individual provider contracts.
Prior experience in behavioral health/substance use disorder treatment
Highly self-motivated and capable of communicating virtually with not only providers but also your team and manager
Excellent telephone and written communication skills
Strong organizational skills, process oriented and attention to detail
Provider Relations Manager- Remote
By Prime Therapeutics At , Remote $59,610 - $95,370 a year
Bachelor's degree in a related field, or at least 4 additional years of experience in healthcare, network development, network management.
5-8 years experience in a Provider Relations role for a managed care plan.
Takes the front-line in establishing and maintaining strong communications with providers. Collaborates with Regional Managers and manages staff and support activities.
Solid knowledge of health plan operations required.
Assists with network strategy committee meeting and network application processing decision committees
Collaborates and monitors with credentialing teams to ensure provider compliance with provider and state contracts.
Remote Provider Relations Representative**
By Cotiviti At , Remote $17.50 an hour
High school diploma, GED, or equivalent work experience
Initiates phone calls to customers, (providers/pharmacies/patients/carriers etc.) to confirm receipt of mailings, and to request action.
Provides timely response and resolution for all provider initiated inquires (phone calls, emails or faxes).
Reviews and analyzes documentation and claim data to determine validity and proper action.
Updates accounts receivable system with denial and group information.
Assists with high priority special projects
Provider Relations Manager- Remote
By Prime Therapeutics At Minneapolis, MN, United States
Bachelor's degree in a related field, or at least 4 additional years of experience in healthcare, network development, network management.
5-8 years experience in a Provider Relations role for a managed care plan.
Takes the front-line in establishing and maintaining strong communications with providers. Collaborates with Regional Managers and manages staff and support activities.
Solid knowledge of health plan operations required.
Assists with network strategy committee meeting and network application processing decision committees
Collaborates and monitors with credentialing teams to ensure provider compliance with provider and state contracts.
Lead Director, Network Provider Relations (Medicaid) (Remote Il Based)
By CVS Health At , , Il $100,000 - $227,000 a year
Assist and develop Network Action Plans to ensure Network Compliance with any and/all State Network Compliance requirements
Manages Local Provider Engagement Team to Deploy National Engagement Model
Manages Local Provider Relations staff to ensure Market Leading Provider Satisfaction
Oversees the monitoring of executed provider contracts to ensure Network Access meets State requirements.
Excellent interpersonal skills and the ability to work with others at all levels
Knowledge of Medicaid Regulatory Standards for Network Access, Credentialing, Claims Processing, Provider Appeals & Disputes and Network Performance Standards
Sr. Provider Relations Specialist - Remote
By Prime Therapeutics At , Remote $50,700 - $75,500 a year
Experience using Contract Management software including maintaining and managing databases
Draft and manage communication efforts on behalf of Network Management, Client Engagement, Compliance, and Government Programs to participating pharmacies
Bachelor’s degree in Business or related area of study, or equivalent combination of education and/or relevant work experience
Pharmacy Technician certification (CPhT) or equivalent pharmacy experience
Enhanced organizational skills with the ability to work on multiple projects simultaneously
Expert verbal and written presentation skills
Provider Relations Representative Jobs
By Mindlance Health At United States
Data Entry/plan build experience in Healthcare Insurance systems
This is a remote role
Bachelor’s degree or equivalent work experience preferred
Configure new clients and inforce client changes in the platform
Conduct initial and final validation of platform, client portal and census, as needed
Collaborate with resources to ensure issues are addressed and corrected prior to production completion

Are you an experienced provider relations professional looking for a new challenge? We are looking for a Provider Relations Manager to join our team and help us build strong relationships with our providers. You will be responsible for developing and maintaining relationships with providers, negotiating contracts, and ensuring compliance with regulations. If you have excellent communication and interpersonal skills, and a passion for building relationships, this could be the perfect job for you!

Overview:

A Provider Relations Manager is responsible for developing and maintaining relationships with healthcare providers, such as hospitals, clinics, and physicians. They are responsible for negotiating contracts, resolving disputes, and ensuring that providers are meeting the standards of quality and service set by the organization.

Detailed Job Description:

The Provider Relations Manager is responsible for developing and maintaining relationships with healthcare providers. This includes negotiating contracts, resolving disputes, and ensuring that providers are meeting the standards of quality and service set by the organization. The Provider Relations Manager will also be responsible for monitoring provider performance, ensuring compliance with regulations, and providing feedback to providers. The Provider Relations Manager will also be responsible for developing and implementing strategies to improve provider performance and satisfaction.

What is Provider Relations Manager Job Skills Required?

• Excellent communication and interpersonal skills
• Ability to negotiate and resolve disputes
• Knowledge of healthcare regulations and standards
• Ability to analyze data and develop strategies
• Strong organizational and problem-solving skills
• Ability to work independently and as part of a team

What is Provider Relations Manager Job Qualifications?

• Bachelor’s degree in healthcare administration, business, or a related field
• 5+ years of experience in healthcare provider relations
• Knowledge of healthcare regulations and standards
• Proficiency in Microsoft Office Suite

What is Provider Relations Manager Job Knowledge?

• Knowledge of healthcare regulations and standards
• Knowledge of healthcare provider relations
• Knowledge of healthcare reimbursement and payment systems
• Knowledge of healthcare quality improvement initiatives

What is Provider Relations Manager Job Experience?

• 5+ years of experience in healthcare provider relations
• Experience in contract negotiation and dispute resolution
• Experience in developing and implementing strategies to improve provider performance and satisfaction

What is Provider Relations Manager Job Responsibilities?

• Develop and maintain relationships with healthcare providers
• Negotiate contracts and resolve disputes
• Monitor provider performance and ensure compliance with regulations
• Provide feedback to providers
• Develop and implement strategies to improve provider performance and satisfaction
• Analyze data and develop strategies to improve provider performance and satisfaction