Provider Relations Representative Job Description

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.