Provider Relations Representative
Core
Managing provider contracting, credentialing, and data integrity to support network operations and marketing across all lines of business.
Role type
Provider Relations Representative (Managed Care Operations)
Builds
Provider networks and data systems for health insurance plans
Domain
Health Insurance / Managed Care
Required skills
Provider contracting, credentialing, data integrity, provider community relations, health care administration, contract management, claims processing systems, provider reimbursement methods, organizational planning, analytical skills, independent initiative
Preferred skills
Provider performance analysis, network expansion strategies, multi-department issue resolution, provider-facing reporting tools, physician practice operations, revenue cycle management, advanced Excel, billing and coding basics, CRM systems
Technologies
Word, Excel, PowerPoint, claims processing systems, provider management systems, CRM
Responsibilities
Contracting and credentialing of professional providers, maintaining provider data integrity, leading operational and customer support duties, participating in internal provider meetings and work groups, researching credentialing and network participation problems, providing training and education to contracted providers
Seniority
Mid-level, hands-on IC
