Provider Relations Specialist - Remote from Home

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Posted a day ago United States $55k - 55k (US Dollars)
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Job Description

Provider Relations Representative

Position Description

  • Responsible for maintaining working relationship with the existing network of participating dentists for a specific geographic area.
  • Assists providers with policy and procedure interpretation.
  • Achieves company targets through the implementation of network improvement plans.
  • Assists with recruitment of new providers.


Responsibilities

  • Develops strong interpersonal relationships with assigned providers and maintains regular contact with key contacts.
  • Researches and resolves incoming provider inquiries.
  • Ensures provider network compliance.
  • Assist with business intelligence and market analysis reports.
  • Continuous education and outreach to providers on protocols, policies, and procedures.
  • Ensures that the provider network size and stability meets client growth needs.
  • Assists with recruitment by identifying network gaps and prospective providers within a designated territory.
  • Facilitates the distribution of provider agreements, negotiates rates, and renegotiates contracts.
  • Conducts Quality Management follow-up; coordinates grievance information, including contact with office, record retrieval and resolution follow-up.
  • Coordinates with Utilization Management to monitor provider utilization patterns.
  • Participates on assigned committees to provide ongoing feedback using market conditions, industry trends, and provider insights.
  • Assists with creation, modification or update of standard and non-standard provider agreements and fee schedule addendums.
  • Reviews, analyzes and manages provider reimbursement schedules to ensure that they are cost-effective and meet the recruitment needs.
  • Reviews and analyzes internal data to determine network improvement needs.
  • Conducts provider office site visits to ensure offices meet established guidelines.
  • Ensures provider database and documentation is up-to-date, accurate, and complete.
  • Collects competitive information for ongoing competitor analysis and process improvement
  • Completes new provider orientation for all applicable product lines and ensures new contracts are entered promptly and accurately.
  • Assists with credentialing and recredentialing of provider offices.
  • Assists with the development and implementation of provider training programs.
  • Analyzes changing business requirements; makes recommendations to management for process improvements.
  • Participates in strategizing for membership growth and retention.
  • Performs other duties as required.
  • 50% Calling / 50% Researching.


Job Requirements:
  • Qualifications
    • Bachelor's degree or equivalent experience.
    • Previous customer service experience with exposure to benefits interpretation and provider networking.
    • Previous experience as a Provider Relations Representative.
    • Knowledge of managed care policy, benefit plan design, and provider fee schedules desired.
    • Ability to explain complicated financial terms and utilization data to dentist/staff.
    • Excellent written, verbal and public speaking skills.
    • Strong analytic and problem solving abilities.
    • Strong communication and negotiation skills.
    • Valid driver's license and reliable transportation are required as local travel is required.
    Location : Miami Florida, 33150
    Salary: $55.000 Yearly.
    Schedule: Monday / Friday 8:30 - 5:30 PM ( As long as you work 40 Hrs )
    Travel: 20% of job Requires Traveling, Expenses Covered.