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PROVIDER RELATIONS REPRESENTATIVE

RENO, NV | Full Time
4 Days Ago

Job Description

Responsibilities

Job Summary:  The Provider Relations Representative develops & maintains positive relationships with physicians, providers, and practice managers within the provider network, including oversight & managing performance in various incentives based and/or value-based programs.  Responsible for educational needs of providers and their office staff in any matters concerning provider relationships with Prominence Health Plan and network service issues. Facilitates the development of a comprehensive provider network and serves as the primary contact, offering education, technical assistance and problem solving as necessary. 

Qualifications

Job Duties/Responsibilities:

  • Develop & maintain positive relationships with providers, ensure provider adherence to contractual requirements, and educate providers and office staff on topics including, but not limited to health plan operations/policies and procedures, preventative & quality outcome metrics & risk adjustment.
  • Responsible for understanding, developing, tracking, monitoring and reporting on key programs performance metrics, such as STARs, HEDIS, and other quality performance measures. 
  • Prepares for and participates in meetings with providers and provider staff and plans, creates & delivers agendas and/or presentations. 

Requirements:

  • High School Graduate/Equivalent
  • Knowledge of provider reimbursement, Medicare reimbursement, coding and Hedis Measures and care gap reporting preferred.
  • Knowledge of Medicare Advantage and ACA risk scores and ability to educate providers and key levers to further enable the health plan’s success
  • Understanding of provider office dynamics and optimal approaches to communicating and educating providers and provider staff
  • Understanding of provider reimbursements and coinciding challenges (FFS, CPT code reimbursement, etc.)
  • Understanding of health plan departments and functional areas for problem resolution
  • Experience in customer service/relations-like roles
  • Ability to effectively communicate in English, both verbally and in writing.
  • Proficient in Microsoft Office skills (Excel, Word, Access, etc.) 
  • Enjoys working in both individual and team settings
  • Problem solver – enjoys problem solving 
  • Self-starter, resourceful and able to execute projects in a fluid and fast paced environment
  • Good communication and relationship skills
  • Strong analytical skills
  • Attention to detail
  • High level of energy

Skills for PROVIDER RELATIONS REPRESENTATIVE

The job skills required for PROVIDER RELATIONS REPRESENTATIVE include Customer Service, Problem Solving, Medicare, Microsoft Office, CPT,and Communicates Effectively etc. Having related job skills and expertise will give you an advantage when applying to be a PROVIDER RELATIONS REPRESENTATIVE. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by PROVIDER RELATIONS REPRESENTATIVE. Select any job title you are interested in and start to search job requirements.

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Career Path for PROVIDER RELATIONS REPRESENTATIVE

The following is the career advancement route for PROVIDER RELATIONS REPRESENTATIVE positions, which can be used as a reference in future career path planning. As a PROVIDER RELATIONS REPRESENTATIVE, it can be promoted into senior positions as a Provider Relations Representative Sr that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary PROVIDER RELATIONS REPRESENTATIVE. You can explore the career advancement for a PROVIDER RELATIONS REPRESENTATIVE below and select your interested title to get hiring information.