The main duty and responsibility of a Provider Relations Manager are to work with affiliated companies and ensure that the negotiations settled are at the best deal for their organization. The job description ensures managing long-term contracts with various providers, making sure the supplies and other contracts are carried out as per the agreed terms and conditions; ensuring quality relationships between clients and the company; resolving provider issues, contract agreements, and non-routine claims. The Provider Relations Manager Resume also lists the crucial task of overseeing the group of workers and monitoring their relationship with providers.
Summary of skills that can highlight a resume includes the following – strong communication skills; the ability to negotiate terms and conditions with providers; conflict resolution skills; strong management skills; and technical capabilities. The ideal candidate for this post should mention on the resume a degree in business or the like.
Headline : 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 : Microsoft Word, Microsoft Excel, Management, Marketing, Medical Terminology, Sales.
Managed daily/monthly activities improving results, including costs, transaction methods, staffing and SLA performances for Provider Relations, Provider Enrollment, Eligibility, HIPAA, and EHR.
Organized quarterly Stakeholder meetings to identify Medicaid trends, transaction billing issues and changes within the scope of the New Mexico Medicaid program.
Planned and developed best practices, process improvements, and effective programs for quality, training and employee retention.
Developed appropriate outreach parameters for Provider Field Representatives to meet the Clients expectations.
Updated the Activity Based Compensation (ABC) employee payment program for the Provider Relations department which led to an increase of employee productivity and a cost savings of 17% for calendar year 2015.
Initiated, processed and finalized payroll for 117 employees on a monthly basis.
Dramatically improved the Provider Relations department's attrition rate to 5% for ending calendar.
BA In Psychology
Sr. Provider Relations Manager Resume
Summary : Result oriented professional with 14 years of Provider Relations experience. Extensive knowledge base in oral and written communications, making presentations, problem solving, time management and the ability to think and act independently with attention to detail.
Skills : Payor Contracting, Managed Care, Marketing, Data Analysis, Network Management, Medicare.
Provided the analytical frame work required for executive decisions in areas of business development of internal and external provider networks.
Developed Strategies to increase revenues, and achieve business objectives.
Contracted management of over 50 million per year.
Implemented and monitored strategic initiatives of special projects which have included opening seven optical facilities, chemo infusion offices and urological procedure facilities.
Managed 5 Provider Relation Representatives for multiple states Assist in resolution of provider issues and member complaints and/or grievances Act as .
Led the ICD-10 operations implementation team and established the operations contingency plan for New Mexico.
Maintained the ICD-10 project scheduling by coordinating and data reporting.
Human Resources Management
Jr. Provider Relations Manager Resume
Objective : Results-oriented, self-motivated and outgoing. Fourteen years of progressive healthcare Operational, Sales and Marketing background. Positions include Hospice Executive Director, Provider Relations Manager, Hospital Liason, Admissions and Marketing Director in Long-term Care. Excellent customer relations, communication, organization and team leadership skills.
Skills : Team Building, Analytic and Problem-Solving, Customer Service, Recruiting, Strategic Planning & Implementation, Management.
Responsible for the evaluation of facilities to carry out the contracting process.
Performed analysis of Hospital Claims Evaluation to receive and process payments.
Acted as a liaison between Blue Cross of Puerto Rico and its providers' network.
Performed investigations of claims made by the providers' network.
Conducted meetings with representatives or upper management of the partner groups to review products and services as part of the strategies for expansion of enrollment.
Responsible for visiting partner groups to discuss and clarify issues.
Supervised, trained and assigned daily tasks to employees.
Master In Public Health
Provider Relations Manager III Resume
Summary : Reviewed and respond to health plan questions involving pre-existing, detailed claim explanation, accurate benefit interpretations and advised of plan exclusions, limitations and state mandates for policies. Followed-up, with adjusters, verifying all information received, and status of outstanding bills.
Led, monitored, motivated, and trained 8 team members in the provider relations unit Ensured language and transportation orders were staffed accordingly.
Developed and implemented industry related terminology and reference manuals Developed and implemented service processes Interviewed, hired, and trained team members according to company needs Produced.
Monitored quarter and annual performance reviews by meeting one on one and in groups with team members Recommended or promoted top performance agents according to skills, work performance and qualifications.
Communicated with patients about account balances and insurance inquiries.
Collected payment, set up payment arrangements, inform patient of financial assistance programs.
Run cost estimates for procedures and collect patient deposits.
Obtained prior authorization and verify benefits for the hospital clinics.
Provider Relations Manager II Resume
Summary : Looking for an opportunity utilizing skills in provider relations, management, human resources, Manage multiple projects, collect and analyze data and disseminate to appropriate department as necessary. Responsible for balancing, auditing and reconciling AR and AP accounts. Provide Insurance Companies additional correspondence when requested.
Skills : Word, Excel, Google+, Powerpoint, Micrsoft Access, Microsoft Project, Visio, Skype For Business.
Recruited selecte Providers and negotiate provider contracts within established parameters.
Served as plan liaison to an assigned panel of contracted providers in order to assure effective communications, prompt problem identification and solution, and maintenance of consistently positive working relationships.
Assisted in the credentialing process of network providers.
Conducted orientation and re-orientation sessions for providers and key administrative staff, on a group or individual basis, to assure that providers and contractor personnel are fully informed about plan policies and procedures.
Monitored provider compliance with contractual requirements, and plan policies and procedures.
Conducted informal and formal site visits to assist in evaluating the quality and effectiveness of contracted or prospective providers.
Reviewed and analyzed qualitative and quantitative information to assess provider performance, and makes recommendations for plan action including corrective actions, contract terminations and other interventions.
Provider Relations Manager I Resume
Summary : Licensed healthcare leader with over 15 years of client focused delivery supporting strategic plans through implementing productivity, quality and client service standards, resolving client issues and delivering on priorities and identifying areas for operational improvements and changes resulting in greater client satisfaction within budget and on schedule.
Facilitated fact-based problem analysis, metrics, business standards, and state wide solutions resulting in cost containment and improved work processes and policies.
Supported multiple state agencies, Medicaid provider community, and interdepartmental staff ensuring successful service delivery.
Directed field based staff through mentorship and team oversight ensuring delivery of high quality provider support and contractual compliance.
Managed multiple large projects through successful analysis, budget estimating, project timeline forecasting, system development, transition planning, and implementation Served as subject matter expert in federal and state fraud and abuse investigations.
Integrated Programs Director Managed contractual requirements and program changes based on contract proposal responses and implementation of new contract requirements.
Directed the Texas Medicaid Children with Special Healthcare Needs, Family Planning, Long Term Care, Medical Policy Claims Adjudication and Medical Policy Development teams meeting contract compliance in all areas.
Led design and operational solutions related to future growth in Texas state healthcare.
Associate In Nursing
Assistant Provider Relations Manager Resume
Summary : Objective is to develop skills and knowledge with an established company in the field of healthcare administration. Believe that educational background as well as professional experience will prove to be an asset to your organization. Please note that will be relocating to San Diego, CA effective.
Conducted weekly presentations to doctors' offices to pinpoint qualifying symptoms of their patients that may qualify for hospice.
Provided consultations to families when doctors refer patients to hospice.
Implemented and managed a Provider Call Center to assist providers and their office staff; averaged over 3,000 calls a month Trained eleven employees .
Collected and reported information on the assigned panel of providers in order to assure that the plan provider database is current and correct.
Participated in all network development and departmental projects as needed including Provider Access and Availability Studies and Provider Directory production.
Provided Workers Comp Carrier and Pip Adjuster with bills and notes in a timely fashion in order to get our bills paid promptly.
Followed-up, with adjusters, verifying all information received, and status of outstanding bills.
Associate Provider Relations Manager Resume
Objective : Certified Pharmacy Technician who has worked in both retail and mail order for 23 years. Registered in both Nevada and Tennessee. Experienced in state rules and regulations as well as compliance. Set up dispensaries in physician offices and pharmacies. Well versed in pharmacy contracting, obtaining necessary licenses and permits.
Skills : Microsoft Office, Datascan Pharmacy Services.
Developed and reinforce positive relationships with physician members, administrators and office managers.
Responsible for all aspects of daily operations of the network as well as, implementation and maintenance of credentialing, enrollment of physicians .
Promoted hospice services and outstanding clinical outcomes to recognize the company as the industry leader.
Ranked 3rd of 85 nationwide for admissions Developed relationships throughout Southwest Iowa and Eastern Nebraska with area hospitals, physicians, .
Performed periodic meetings with providers in their offices, hospitals, clinical laboratories or other locations as necessary.
Developed and delivered programs to provide training to provider associates designed to improve the member experience and simplify administration.
Responsible for generating revenue and developing business by creating and maintaining existing relationships with physicians and other medical.
Associate Of Arts
Assistant Provider Relations Manager I Resume
Summary : To utilize and demonstrate the knowledge, leadership skills and strengths developed over 20 years in the healthcare industry.
Skills : ASQ Certified Manager Of Quality, Organizational Excellence.
Responsible for oversight of the Passport provider network which includes over 6500 providers in 1300+ locations.
Provided oversight of provider orientation and education including the development and execution of annual workshops, site visits to monitor provider compliance with contractual requirements and Plan policies, and review of both State and Federal Medicaid guidelines.
Developed content and participated in Provider Committees.
Placed strong emphasis on root cause identification in order to implement long term solutions for participating providers.
Managed contracting with hospitals and other providers Developing networks Ensures provider database and documentation is up-to-date, accurate.
Monitored the community's health care needs, delivery systems and satisfaction levels while recommending services and programs that address the new and .
Increased sales of home medical equipment through generating new accounts on a regular basis.
Provider Relations Manager Resume
Summary : Talented Contracting Manager proficient at collaborating with multiple stakeholders to determine audience interest and develop strategic go-to-market communication plans that align with the company's business priorities and initiatives.
Skills : Program Management, Meeting Planning, Content Development, Change Management, Instructor, Public Speaking, Relationship Management.
Interfaced with market leaders to align contracting needs and business efforts.
Facilitated Provider education on company systems, policies and strategies.
Set target goals in order to meet national and market-specific network needs.
Re-credentialed existing providers to maintain all up-to-date documentation, licenses, state requirements, cost guidelines.
Facilitated and instruct company-wide classes, annually, for groups of 150+ employees.
Administered quality assurance and random facility site visits for providers.
Spearheaded Physician Marketing Program to include selling of TechHealth products/services.