Supports, develops and maintains service relationships with all participants (physicians, providers and administrators) of a provider network. Responds to electronic and direct inquiries from clients about policies, rates, changes, referrals, eligibility, credentialing, etc. Typically requires a bachelor's degree. Typically reports to a supervisor or manager. Works on projects/matters of limited complexity in a support role. Work is closely managed. Typically requires 0-2 years of related experience.
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Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an imp...
Position Title. Provider Relations Representative. Department. Network Management. Level. Non-Supervisory. Reports To. Director of Network Management. Position's Access to Private Health Information (PHI). Requires access to PHI, including “read only” access to eligibility, claims, and authorizations. “Write” access to member notes and provider notes. Job Classification. Non-Exempt. Job Type. Full-Time. Pay Rate. $27.89 - $35.27/hr. Salary is bas...
Responsibilities. Job Summary. Provider Relations Representative is responsible for assisting in the full range of provider relations and service interactions for all lines of business within Prominence Health Plan. Will assist in the design and implementation of programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Supports those who direct and imple...
American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Mi...
The Provider Relations Specialist for the continued development, implementation, compliance management of a cost-effective provider network, and support the day to day operational needs. This role will assist in the development of network-wide strategies to improve efficiencies and access. Under the direction of the Director of Managed Care, s/he performs all critical functions necessary to assess, develop, maintain, and/or improve provider netwo...
POSITION SUMMARY/RESPONSIBILITIES. Provider Relations Representative works as the primary liaison between Community First Health Plans and network participants (physicians, providers, and administrators) of the health plan provider network. This position will build and nurture positive relationships with health plan network participants by providing the on boarding orientation, and delivering guidance and high-quality service through regular enga...
American Health Plans manages institutional special needs plans (I-SNPs) in nursing homes in several states by sharing plan ownership with the facilities. Our roots in managed care run deep. We owned and managed a Medicare Advantage plan with over 100,000 members across multiple product lines. We currently own one of the oldest provider-owned I-SNPs in the country and are rapidly developing new partnerships with nursing home owners. Today, you ca...
Responsibilities. Job Summary. Provider Relations Representative is responsible for assisting in the full range of provider relations and service interactions for all lines of business within Prominence Health Plan. Will assist in the design and implementation of programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Supports those who direct and imple...
Responsibilities. Direct daily interaction with Health Care Providers and agency staff. Educate community about our services and serve as a liaison between potential participants, the program and community resources. Willing to travel and do community presentations. Maintain a thorough understanding of agency services, and policies to effectively assist participants. Utilize phone etiquette skills to ensure positive interactions with customers. C...
Jai Medical Systems Managed Care Organization, Inc. was founded in 1997 and serves a diverse population of children and adults throughout the State of Maryland. Since our founding, Jai Medical Systems' mission has been to provide high quality healthcare benefits and services to the people of Maryland. We continue this tradition of quality and excellence by working with our members to help identify their healthcare needs, while remaining an active...
Job Description. Job Description. Position Purpose. Exercise the duties and responsibilities delegated to the Provider Relations Representative with the outmost professionalism and dedication. . Responsibilities. Responsible for conducting provider orientations of newly contracted providers within the specified time frames as indicated in Policy & Procedure PR – 01. Responsible for securing a signed Notice of Educational In - Service Acknowledgem...
Job Summary. The Provider Relations Representative is responsible for the development and execution of a business plan in a defined field territory for the purpose of growing patient referrals for a large physician practice. The position is responsible for building strong customer relationships to gain patient referral loyalty. assisting with corporate marketing program planning development and execution and the management of a customer relations...
