Provider Relations Representative Resume Samples

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Provider Relations Representatives build and cultivate relationships with users and ensure a high level of customer service. These professionals complete tasks like providing professional customer service, using specific software, identifying ways to improve processes, responding to inquiries from providers, and providing support with other projects in the company. Based on our selection of resume samples in the field, the most sought-after assets are technical skills, customer service orientation, conflict resolution, relationship management, and strong communication and interpersonal abilities. The ideal candidate should be able to showcase in his or her resume a Bachelor’s Degree in business or another relevant field.

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1

Provider Relations Representative

Responsible for daily interaction with providers and staff to ensure provider satisfaction and to achieve targeted goals for Bergen, Passaic, Hudson, Essex, Union, Warren, Sussex and Morris counties, in addition to 4 counties in Pennsylvania.

  • Planned, organized and conducted orientations and site visits
  • Recruited physicians in accordance to network requirement goals
  • Negotiated and renegotiated contracted with physicians/physicians group
  • Assisted in credentialing and re-credentialing process to ensure provider's applications are correct and expedited. Claim resolution.
  • Built and maintained professional relationships with the providers to ensure provider satisfaction
Candidate Info
34
years in
workforce
1
year
at this job
BS
Management
2

Provider Relations Representative

  • Researched and resolved disputes, billing discrepancies and claims immediately with regard to customer satisfaction
  • Established and fostered strong, positive relationships with key providers by coordinating, facilitating and leading partnership meetings and identifying on site enrollment opportunities for marketing
  • Prepared and reviewed claims and ensured that claims were executed and paid in a timely manner
  • Investigated and resolved member complaints regarding providers to maintain member and provider satisfaction
Candidate Info
8
years in
workforce
1
year
at this job
HS
Audio Technology
BA
English Communications
3

Provider Relations Representative

Acted as a liaison between Providers and the company regarding contract and data compliance. Held meetings with providers to review new policies, products and issue resolution.

  • Secured and serviced contracts with large health care systems, clinics and individual provider offices for network expansion.
  • Proofed, updated and distributed provider directories for Southeastern and South Central Wisconsin provider networks.
  • Co-chaired HealthPlan Credentialing Committee.
  • Performed NCQA compliant site audits of Primary Care Providers.
Candidate Info
19
years in
workforce
2
years
at this job
AA
Healthcare Management
BS
Business Administration
4

Provider Relations Representative

  • Addressed and resolved provider issues regarding reimbursement, proper utilization of policies and procedures, and coordination of resolution through provider education.
  • Maintained technical knowledge regarding Independent Health's contracts and benefits and working knowledge of policies and procedures.
  • Utilized Power MHS and Core Plus systems for obtaining benefit and claims information. Documented correspondence using the IMAX system.
Candidate Info
11
months in
workforce
11
months
at this job
BS
Management And Marketing
5

Provider Relations Representative

Provide servicing and support to the provider network in Central PA including 100 PCP offices, 130 specialty groups, Holy Spirit Hospital, Pinnacle Physician Network and Hershey Physician Network.

  • Respond to provider/hospital inquiries concerning contract and claims issues.
  • Provide physician/hospital orientations to support ongoing education of health care provider community.
  • Develop and deliver presentations on various Gateway topics to the provider community.
  • Awarded "Recognition of Excellent Customer Service" in 2008 and 2009.
Candidate Info
37
years in
workforce
8
years
at this job
Marketing
6

Provider Relations Representative

  • Verified provider applications for completeness, initiated the credentialing/re-credentialing process including Site Survey visits
  • Conduct new provider orientation for primary care and specialty physicians
  • Identified potential claims trends and follow-up with provider and internal departments to ensure resolution of problems
  • Conducted on going trainings to provider regarding any upcoming changes, Educate provider properly on the MLR. Provide continuous face-to-face service/educational meetings ensuring provider and staff understand company policies and procedures
Candidate Info
11
years in
workforce
2
years
at this job
BA
Business Administration
7

Provider Relations Representative

  • Handle inquiries from physicians, which are received by phone or email which can included billing, network status or provider issues.
  • Interact with providers and hospital staff to resolve claim and benefit related issues by creating a SP ticket, in which our third party administrator will open and reprocess claims based on direction provided.
  • Record and log all pertinent communication including inquiries and concerns.
  • Build and maintained strong professional relationships with medical units and member service departments.
  • Efficiently and accurately managed provider requests for demographic information such as tax identification numbers and new addresses.
  • Responsible for LLHPHYSICIAN email box and LLH Provider Relations voicemails: intake, respond and completed all requests.
  • Investigate and resolve member complaints regarding providers to ensure satisfaction at both levels
Candidate Info
3
years in
workforce
6
months
at this job
BA
Spanish
8

Provider Relations Representative

  • Responsible for proactive support of plan providers and staff including orientation, education, and the scheduling of on - site visits as well as incorporating plan's policies and procedures and for fostering a positive perception of the plan among providers.
  • Communicated provider issues to Health Net Claims Department for timely resolution.
  • Facilitated smooth work flow between Network Management and various departments within Health Net on a daily basis
  • Liaison between physician community and Health Net's Medical Management Team
  • Developed working relationships with upper management of hospital based faculty practices and large multi physician specialty groups
  • Facilitated projects in a timely manner and prioritize according to provider needs
Candidate Info
8
years in
workforce
1
year
at this job
C
Medical Coding
Phlebotomy
Pursuing
9

Provider Relations Representative

Maintain regular contact with providers and act as a liaison to resolve claims and complex issues.

  • Responsible for completing the annual Provider Incentive Payment (PIP) Report.
  • Recruit providers for Medicare duals product.
  • Responsible for uploading and verifying information for the monthly and annual provider directory.
  • Responsible for ensuring that the 4275 weekly report (Provider Report for the State) is free of errors.
  • Educate providers on new procedures, HEDIS reports, Healthy Michigan Plan and any new Plan initiatives.
  • Collaborate with the outreach department in community events.
Candidate Info
15
years in
workforce
4
years
at this job
BBA
Communication
MA
Master of Arts
10

Account Manager/ Provider Relations Representative

  • Build and maintain relationships with physicians, office staff and collaborate closely with Sales Representatives to provide a high level of customer experience.
  • Review fund allocations and expenses for accounts at daily, weekly and monthly intervals to ensure surplus and deficits are credited appropriately based on payment schedules and claim submission.
  • Reduce delinquency and retain customers by utilizing experience, judgement, and resources to plan and accomplish department goals.
  • Responsible for cost containment efforts resulting in over 5.8 million dollars. Responsible for cost containment efforts resulting in over 5.8 million dollars.
  • Serve liaison for multiple lines of business including but not limited Medicare HMO, Commercial, PPO, and Medicare Supplement.
  • Serve as single-point of contact for specialist, primary care physician, multi-specialty groups and hospital systems in the Southeastern region.
Candidate Info
7
years in
workforce
3
years
at this job
HS
High School Diploma
BA
Organizational Management

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