Provider Relations Representative
Core
Facilitate and maintain cooperative working relationships with contracted providers, ensuring adherence to contractual and financial requirements while resolving issues and providing education on Medicaid and Medicare processes.
Role type
Provider Relations Representative
Builds
Provider network operations and service delivery
Domain
Health insurance / Managed care
Deliverable
client delivery
Required skills
Medicaid/Medicare business processes, provider reimbursement methods, claims processing systems, contract management, issue tracking and resolution, trend identification, provider education, analytical skills, presentation skills
Preferred skills
Medical insurance operations support, claims handling, stakeholder relationship management, process improvement, multi-market provider support
Technologies
Word, Excel, PowerPoint, claims processing systems
Responsibilities
Support providers on medical insurance and claims-related inquiries, track and resolve provider issues, identify trends and evaluate provider performance, educate providers on policies and processes, address provider requests across a national scope
Seniority
Mid-level, hands-on IC