Provider Relations Representative
- 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.
- 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.
Location : Miami Florida, 33150
- 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.
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.