Provider Relations Representative Job Description Template
We are looking for a provider relations representative to liaise with healthcare providers and clients on healthcare-related issues, of which the majority are related to claims and provider participation. You will also be required to enter claims data for processing.
To ensure success as a provider relations representative, you should be highly organized and have excellent communication skills. Ultimately, a top-notch representative should resolve queries and train healthcare providers to ensure operational efficiency.
Provider Relations Representative Responsibilities:
- Initiating and maintaining effective channels of communication with service providers and clients.
- Gathering, reviewing, and verifying all pertinent information relating to participating healthcare providers.
- Establishing and maintaining relationships with assigned healthcare providers through office visits, telephone calls, prompt resolution of issues, and excellent customer service.
- Conducting training of service providers on policies, procedures, service lines, and available technology.
- Answering questions from doctors' offices on benefits.
- Gathering, reviewing, and submitting relevant documentation needed for claims processing.
- Managing healthcare provider accounts to achieve company strategies and goals.
- Maintaining a working knowledge of all applicable federal, state, and local laws and regulations regarding healthcare.
- Assisting help desk staff with more complicated benefit queries received.
- Identifying shortfalls in healthcare provision and initiating improvement opportunities.
Provider Relations Representative Requirements:
- A bachelor's degree in healthcare administration or equivalent.
- A minimum of 2 years' experience in client services, provider relations, and claims processing.
- Knowledge and understanding of claims processes and data capturing.
- Proficiency in creating presentations, training documents, reports, and analytical graphs.
- Proficiency in MS Outlook, Excel, and Word.
- Ability to work independently.
- Excellent verbal and written communication skills.
- Good problem-solving skills.