Top 5501 Provider Relations Representative Jobs

Provider Relations Representative I (Hybrid)
CareFirst BlueCross BlueShield —Baltimore, MD
- $49,464 - $98,241 a year
- Full-time
- Microsoft Word
- Microsoft Access
- Up to 50% travel
Quick Apply
Provider Relations Representative (Remote in AZ - Pima or Pinal)
Imperial Management Administrators Services Inc —Arizona
- $30 - $32 an hour
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Marketing
Quick Apply
Provider Relations Representative
Key Family of Companies —Indianapolis, IN
- Full-time
- Remote
- Mid-level
- 3 years
- Analysis skills
- Health insurance
Quick Apply
Telephone Representative II (Provider Relations)
1199SEIU Family of Funds —New York, NY
- $49,495.68 - $62,570.04 a year
- Full-time
- Research
- Mid-level
- High school diploma or GED
- Vision insurance
Medicaid Provider Relations Rep II
Moda Health —Portland, OR
- $54,668.32 - $68,340.67 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Research
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Tele Support Representative 1
Tranzeal Inc —Remote
- $20 - $22 an hour
- Contract
- Remote
- High school diploma or GED
- Continuous improvement
- Communication skills
- Professional development assistance
Quick Apply
4d
Community Relations Representative-Atlanta,GA
Smooth Mooove Senior Relocation Services, Inc. —Remote
- From $55,000 a year
- Part-time
- Business development experience
- Driver's License
- Reliable transportation
- Opportunities for advancement
Quick Apply
Provider Relations Representative - PCP
Humana —Virginia
- $59,300 - $80,900 a year
- Full-time
- Mid-level
- Office
- Travel
- Paid parental leave
- Paid holidays
8d
Physician Relations Representative (Pathology & Diagnostic Laboratory Sales)
GoldPath Labs —Remote
- $60,000 - $250,000 a year
- Full-time
- Remote
- Marketing
- Mid-level
- Driver's License
- Travel reimbursement
- Mileage reimbursement
Quick Apply
Associate Representative, Health Plan Provider Relations - Remote must reside in UT
Molina Healthcare —Utah
- $18.04 - $35.17 an hour
- Full-time
- Remote
- Medical office experience
- Research
- Communication skills
- Health insurance
Provider Relations Representative - Hybrid
UPMC —Pittsburgh, PA
- $22.52 - $37.40 an hour
- Full-time
- Bachelor of Science
- Mid-level
- Office
Lead Evaluator, Early Learning (Part-Time)
Cognia, Inc. —Remote
- $40,000 a year
- Part-time
- Remote
- School experience
- High school
- Bachelor of Science
Quick Apply
PROVIDER AND CLIENT SERVICES REPRESENTATIVE
NORTH EAST MEDICAL SERVICES —Burlingame, CA
- $32.08 - $36.15 an hour
- Full-time
- Microsoft Outlook
- Word processing
- Computer literacy
- Health insurance
- Dental insurance
Financial Clearance Representative I - Remote
Roswell Park Cancer Institute —Buffalo, NY
- From $21.81 an hour
- Full-time
- Remote
- High school diploma or GED
- 1 year
- Communication skills
Representative, Health Plan Provider Relations - Remote Must reside in NY
Molina Healthcare —New York, NY
- $19.84 - $46.42 an hour
- Full-time
- Remote
- Medical office experience
- Mid-level
- Travel
- Health insurance
Senior Provider Relations Representative
Optum —San Diego, CA
- $72,800 - $130,000 a year
- Full-time
- 5 years
- Computer literacy
- Pass drug screening
Quick Apply
Internal Provider Representative
PROVIDER NETWORK SOLUTIONS OF PUERTO RICO LLC —San Juan, PR
- Full-time
Quick Apply
Representative, Provider Relations
BlueCross BlueShield of South Carolina —Columbia, SC
- 8 hour shift
- Nursing
- Microsoft Access
- Sales
- Health insurance
- Dental insurance
10d
Sr. Provider Relations Representative
CLAREMEDICA HEALTH PARTNERS LLC —Miami, FL
- Spanish
- English
- Ability to climb stairs
Quick Apply
Provider Relations Representative
Community Behavioral Health. —Philadelphia, PA
- $50,622 - $58,000 a year
- Full-time
- Writing skills
- Mid-level
- Bachelor's degree
Quick Apply
8d

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Provider Relations Representative I (Hybrid)

CareFirst BlueCross BlueShield -
Baltimore, MD

Quick Apply

Job Details

Full-time
$49,464 - $98,241 a year

Qualifications

Customer training
Medical claims processing
Spreadsheets
Corporate training
Presentations for conferences or internal meetings
In-person customer service
Internal employee customer service
Customer relationship management

Full Job Description

Resp & Qualifications

PURPOSE:
This role enables a seamless provider experience serving as a primary liaison with stakeholders within Health Services and across the company. Provides communication, education, issue/dispute resolution and support of managing all of CareFirst's contracted in-network providers including independent professional practices, health systems, hospitals, and ancillary providers across all lines of business.

We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.

ESSENTIAL FUNCTIONS:

RELATIONSHIP MANAGEMENT:

Establishes and maintains relationships with providers and key stakeholders, by ensuring regular communications and timely problem resolution. Leverages provider relationships to drive and influence provider behavior towards favorable outcomes in support of corporate initiatives and positive member interactions.

TRAINING AND EDUCATION:

Provides ongoing and targeted training and education to provider community ensuring they can successfully utilize electronic tools, navigate provider portal, follow established processes and procedures. Partners with Provider Training and Education Department to educate providers ensuring they are engaged in the value of our programs in support of positive member interactions.

ISSUE RESOLUTION:

Provides research, resolution and support for escalated service-related issues, using expertise and coordinates between multiple parties across CareFirst. Identifies and resolves root cause, either independently or through formal resolution processes. Offers timely response to providers, management, and other internal customers via virtual or face-to-face visit, correspondence, e-mail, and/or phone as appropriate.

PROJECT MANAGEMENT:

Supports network projects and outreach initiatives that must be special handled by Provider Relations in order to mitigate risk to CareFirst, supplement existing technology, maintain critical operations, support corporate initiatives including but not limited to provider experience scores, STAR ratings, HEDIS measures, and CAHPS program.

QUALIFICATIONS:

Education Level: Associate's Degree OR in lieu of a Associate degree, an additional 2 years of relevant work experience is required in addition to the required work experience.

Experience: 2 years experience with CareFirst computer systems (or comparable technology platforms), networks, products, policies, and procedures, including experience with providers, training, customer service, and claims processing.

Preferred Qualifications:

Bachelor's Degree in business, healthcare administration or related industry.

Knowledge, Skills and Abilities (KSAs)

Working knowledge of provider billing and coding mechanisms, including special pricing, medical terminology, CPT coding and CMS-1500 or CMS UB -04 claim formats.
Knowledge of managed care industry legislated and regulated requirements, health care financial matters and third-party payment methodologies.
Previous experience working either at CareFirst, an insurance plan, a hospital or a physician hospital organization (PHO).
Understanding of contractual documents and ability to effectively communicate terms to providers.
Ability to work effectively using Microsoft Excel, Microsoft Access, Microsoft PowerPoint and Microsoft Word.
Ability to determine priorities and meet deadlines. Self-motivation, and the ability to work independently and manage competing priorities to meet the needs of varying stakeholders and comply with varying mandated deadlines.
Written and verbal communication including excellent customer service skills.
Problem-solving ability, critical thinking, and analytical skills.
Ability to help navigate, de-escalate, and resolve interpersonal conflict that can arise in client-facing roles.
Effective presentation skills with ability to facilitate meetings, presenting information, and public speaking.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Travel Requirements
Estimate Amount: 50% Frequent travel to provider offices, hospitals, medical offices.

Salary Range: $49,464 - $98,241

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Provider Relations and Education

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

#LI-NH2

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Refine Your Search

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