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Provider Relations Specialist 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
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
Provider Relations Specialist (Remote-New York)
By Maximus At United States
3+ years of Health Plan Provider Relations, Recruiting and Vendor Management experience required.
Responsible for appropriate documentation of recruitment and relationship management activities in tracking system
Assist with monthly and quarterly reporting to Management/Credentialing/Operations Support Unit
Performs other duties as may be assigned by Management.
Bachelor's degree in related field, or equivalent combination of education and experience.
This is a fully remote position located in the state of New York.
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.
Owner Relations Specialist Jobs
By Grayson Mill Energy At Greater Houston, United States
Skilled in professionally navigating challenging situations with owners in a calm and respectful manner, escalating to management when needed
Ability to simultaneously work on multiple owner inquiries and maintain effective management of high-volume transactions
Knowledgeable experience in answering owner inquiries covering a span of topics to include,
Maintain working knowledge of ongoing GME projects that could impact owners
Experience with W Energy Software preferred
Excellent communication skills, both written and verbal, and strong interpersonal skills
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
Utility Provider Research Specialist
By Conservice At , Logan, 84321, Ut $16.50 an hour
Ability to manage several different projects at different stages with ease
Experience seeing projects through the full life cycle
Strong interpersonal skills and extremely resourceful
Drive research projects from start to finish
Determine and define project scope and objectives
Work with PayOps team to determine credit card spend and provider lists

Are you looking for an exciting opportunity to join a dynamic team and make a difference in the healthcare industry? We are looking for a Provider Relations Specialist to join our team and help us build strong relationships with our healthcare providers. You will be responsible for developing and maintaining relationships with providers, negotiating contracts, and ensuring compliance with regulations. If you are a motivated individual with excellent communication and organizational skills, this could be the perfect job for you!

Overview Provider Relations Specialists are responsible for managing relationships with providers, ensuring that they are compliant with regulations and providing them with the resources and support they need to provide quality care. They are also responsible for developing and maintaining relationships with providers, negotiating contracts, and resolving any issues that may arise. Detailed Job Description Provider Relations Specialists are responsible for managing relationships with providers, ensuring that they are compliant with regulations and providing them with the resources and support they need to provide quality care. They are also responsible for developing and maintaining relationships with providers, negotiating contracts, and resolving any issues that may arise. They must be able to communicate effectively with providers, understand their needs, and provide them with the resources and support they need to provide quality care. They must also be able to identify and resolve any issues that may arise between providers and the organization. Job Skills Required
• Excellent communication and interpersonal skills
• Knowledge of healthcare regulations and laws
• Ability to negotiate contracts
• Ability to identify and resolve issues
• Ability to develop and maintain relationships with providers
• Ability to analyze data and make decisions
• Ability to work independently and as part of a team
Job Qualifications
• Bachelor’s degree in healthcare administration, business administration, or related field
• At least two years of experience in provider relations or a related field
• Knowledge of healthcare regulations and laws
• Ability to negotiate contracts
Job Knowledge
• Knowledge of healthcare regulations and laws
• Knowledge of provider relations and contract negotiation
• Knowledge of healthcare industry trends
• Knowledge of healthcare reimbursement systems
Job Experience
• At least two years of experience in provider relations or a related field
• Experience in contract negotiation
• Experience in developing and maintaining relationships with providers
• Experience in analyzing data and making decisions
Job Responsibilities
• Develop and maintain relationships with providers
• Negotiate contracts with providers
• Ensure compliance with regulations and laws
• Provide resources and support to providers
• Identify and resolve any issues that may arise between providers and the organization
• Analyze data and make decisions
• Monitor provider performance and provide feedback
• Prepare reports and presentations on provider relations activities