A Provider Relations Coordinator is hired to coordinate the communication efforts of the company with its clients, providers, and other new clients. Primary accountabilities relating to the role are listed on the Provider Relations Coordinator Resume – establishing relationships with providers; ensuring providers comply with network and government regulations; assisting in networking with new areas, educating providers about the system, serving as the key contact person for resolving problems, and escalating complaints.
Job assets that can highlight a resume include the following – strong communication skills, the ability to discuss all aspects of the company’s services; negotiation skills; patience, and the ability to stay calm while dealing with angry and irate providers or customers. To qualify, job applicants must possess a degree in the field directly related to the working industry. Work experience is as well needed.
Summary : Responsible LPN with excellent Nursing and communication skills demonstrated by 26 years of experience in healthcare. Spent 3yrs in Bath, Hospital on various med - surgical floors to include Labor and delivery, Operating Room and sterile processing, Urology clinic, geriatric and psychiatric nursing.
Skills : Microsoft Office, Account Management, Customer Service, Data Entry.
Description :
Facilitated an on-going assessment of patient/family needs and implementation of interdisciplinary team care plan.
Evaluated patient care needs, prioritized treatment, and maintained patient flow.
Assessed patients and documented their medical histories.
Documented patient information obtained from interviews.
Developed patient care plans, including assessments, evaluations and nursing diagnoses.
Self-directed with astute judgment skills.
Represented the organization to customers, the public, government officials and other external sources.
Experience
10+ Years
Level
Senior
Education
GED
Sr. Provider Relations Coordinator Resume
Summary : Management and Administrative professional offering superior management and administration skills. Proficient in Microsoft Office programs. a strong planner and trainer in human resources and customer relations. Exceeded expectations for military and corporate operations. Able to meet tight deadlines and provide final quality checks on all deliverable documents without compromising quality. Trained to identify and corrects problems as they arise. Holds Active Secret Clearance & DCJS 99#.
Skills : Televox Patient Appointment Reminder System Setup/Admin, Krames StayWell Patient and Family Education Custom Folder Admin.
Description :
Monitored data base systems consisting of over 4,000 Independent Consultants to ensure all Independent Consultants have all required paperwork to meet both Onsite Health, Inc.
Lead a team in efforts to collect required information from potential Independent Consultants with a success rate of 90%.
Actively reached out to and keep continuity with all Regional Managers across the continental United States in regards to their scheduled events, and Independent Consultants who are cleared to work those events.
Successfully developed a documentation system to record all incoming documents from within the continental United States to ensure all pertinent information is accounted for.
Communicated daily with Independent Consultants making their application process run smoothly by providing all information that is needed to complete the lengthy process.
Ensured all discrepancies were caught before they happened ensuring all our records were up to date at all times.
Maintained open lines of communication with both the Director of Human Relations and Vice President of Reserve Component Services; to ensure all details in regards to the Independent Consultants and scheduled events are clear and precise.
Experience
10+ Years
Level
Senior
Education
Bachelors Of Science
Jr. Provider Relations Coordinator Resume
Objective : Seeking a position where education, multilayer of skills and customer service can be utilized with room to advance within the company.
Skills : Interviewing, Mentoring, Microsoft Outlook, Microsoft Office, Microsoft Excel, Supervising, Auditing.
Description :
Assessmented and developed of polices and procedure for compliance with regulatory agencies.
Reviewed contracts to negotiate competitive market rates for Physician's reimbursements.
Insured contracts meet negotiated rates as listed on contracts.
Met yearly to review contractual agreements among contracts.
Assessed and or negotiated of new and existing managed care contracts.
Coordinated and maintained credentialing activities.
Performed queries and extract information monthly.
Experience
2-5 Years
Level
Junior
Education
Certificate
Provider Relations Coordinator III Resume
Objective : Over 11 years' experience as an Administrative Professional, 1 and 1/2 years' experience as a Provider Relations Coordinator for suppliers/vendors. Customer centric approach to tasks being handled. Able to coordinate work effectively and efficiently and responsive to the task at hand.
Skills : Data Analysis Administrative Support Troubleshooting and Problem Solving.
Description :
Organized and prepared contract files for Supervisor approval.
Assisted in writing and maintaining provider relations departmental procedures to be a part of the company manual.
Coordinated and followed up with suppliers/vendors for pending contracts.
Managed individual document files of suppliers/vendors pertaining to insurance, licenses and certifications and ensure they are up-to-date.
Ensured missing information is obtained from those whose negotiations are complete.
Prepared patient charts, pre-admissions and consent forms as necessary.
Responsible for the day-to-day operational issues for medical groups and hospitals with over 40,000 commercial and Medicare members.
Experience
2-5 Years
Level
Executive
Education
Bachelor Of Science
Provider Relations Coordinator II Resume
Summary : Applying for a position that will utilize skills and experience: Possess strong Academic Qualification In-depth knowledge of Provider Contracts Full understanding of Government Programs Familiarity with provider organizational arrangements Comprehensive knowledge of Contract Audit and Payment Reconciliation.
Skills : CPR Certified, Iv Certified, ACLS, TB Certified.
Description :
Verified all physician credentials that participated with the healthcare plan for credentialing and re-credentialing.
Attended Physician Advisory Subcommittee meeting for acceptance and denial of physicians to the plan.
Assisted with preparation for NCQA, committee meetings and Department of Insurance audits.
Assisted provider reps by creating spreadsheets and comparisons which consisted of comparing and merging all Prudential HealthCare physicians with Aetna US Healthcare physicians.
Created and maintained Microsoft Access databases for tracking provider activities.
Created and maintained provider directories.
Trained and supported new employees with using computer software.
Experience
10+ Years
Level
Senior
Education
Bachelor Of Science
Provider Relations Coordinator I Resume
Summary : Energetic and detail-oriented individual with a diverse background in administration and sales. Experienced in working individually and with a team to achieve multiple goals and objectives. As an accomplished multi-tasker with a history of navigating a diverse array of business environments an ability to focus on immediate tasks while prioritizing long-term organizational goals. Seeking a position that will best suit strengths, bringing 14 years of related experience and skills.
Skills : Microsoft Word, Microsoft Excel, Analysis, Data Entry, Detail-Oriented, Motivated, Administration, Customer Satisfaction.
Description :
Responsible for credentialing vendor oversight and the credentialing of all CO-OP participating providers.
Established and maintained confidential electronic practitioner/facilities files.
Processed, tracked and filed credentialing applications within established standards.
Responded to internal and external customer inquiries regarding credentialing status.
Ensured the credentialing database remains up to date and accurate.
Sent welcome letters and CO-OP educational information to all approved providers.
Worked as part of a team to build a provider network in South Carolina meeting SC DOI standards.
Experience
10+ Years
Level
Senior
Education
Diploma In Voice
Assistant Provider Relations Coordinator Resume
Summary : To obtain a challenging position with opportunity for advancement and professional growth, Responsible for documenting incoming phone calls into the phone log and forwarding to the appropriate person; task with returning phone messages left.
Skills : Pitney Bowe, FedEx, Power Ship, Facets, Macess, Cactus 3.11, Excel, MS Word, Outlook.
Description :
Worked with provider's applications and contract.
Copied and scanned providers file and application.
Checking to see if all providers credential information is up to date.
Performed new Provider Credentialing activities including preparation of new Provider files to be presented to the Board or Credentialing Committee per NCQA Standards Ensured compliance with and /or adheres to company HIPAA policies and procedures Reviewed contracts and credentialing applications for completeness.
Conducted outreach calls to providers to obtain missing contract information.
Developed and mailed Welcome Packets to newly contracted providers.
Gathered, researched, compiled and documented physician data used in the Credentialing process.
Experience
7-10 Years
Level
Management
Education
General Business Administration
Associate Provider Relations Coordinator Resume
Objective : Human Resources Coordinator with extensive background in payroll processing, accounting and finance. Proficient in ADP and QuickBooks software.
Responsible for all electronic/paper claims filing via billing system.
Reviewed and analyzed appeals that need processed.
Serve as a liaison in corresponding and communicating with providers and members.
Precisely completed appropriate claims paperwork, documentation and system entry.
Verified and created claim numbers by communicating with various insurance companies.
Correctly coded and billed medical claims.
Verified patient's eligibility and claim status with insurance agencies.
Accurately posted and sent out all medical claims.
Experience
2-5 Years
Level
Executive
Education
Bachelor Of Science
Assistant Provider Relations Coordinator I Resume
Objective : To obtain a challenging position with opportunity for advancement and professional growth, Assisted the marketing department with the creation of a company logo, including working with vendors on logistical information and developing.
Collected and compiled articles regarding health plan trends and mandated changes from health plan senior medical staff, and coordinated the publication of the quarterly provider e-Magazine.
Sent mass network physician communications via fax blast upon request.
Coordinated domestic and international travel arrangements.
processed expense reimbursement reports.
Processed physician paid time off (PTO) requests; conducting quarterly PTO balance audits, creating and submitting reports to management and physicians.
Worked closely with the executive management team on database integrity issues, which resulted in an annual savings of $8 million.
Supervised medical record reviews and conducted site evaluations at doctor's offices across Georgia Used internal database to manage incoming .
Experience
2-5 Years
Level
Executive
Education
BS
Provider Relations Coordinator Resume
Summary : To assist an entity, achieve its goals and objectives, enhancing skills, abilities and professional knowledge in the course of career development.
Skills : Microsoft Office, Excel, Internet.
Description :
Reviewed and analyzed hospital's contractual and economical negotiations according to plan policies, procedure utilization, patient coverage/benefits, comparisons on health market price range and provider's proposals.
Served as primary contact to Providers as well as to Claims' Personnel, Hospital Admissions Department and Hospitals' Administrators Review hospitals' and physicians' accreditations (Boards, Licensures, Mal Practice, Training, Patents, Joint Commission) Service the P.R.
Reviewed & Coded Specialist Providers Department Analyze and make determinations on Provider billing methods and rates.
Assigned price on negotiations considered as 'case by case' Contract Loading,review new,deleted & revised codes and assign pricing rates.
Reviewed company's policies and regulations on compliance to CMS' (Centers of Medicare & Medicaid Services), FDA (Food & Drug Administration), & AMA's (American Medical Association) standards.
Verified Provider's accreditations to qualify in Company's Provider Network.(Licensures,malpractice,boards,joint commission,patents...).
Verified Providers' Tax withhold & notice of Levy's information and enter the information in the IT system.
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