It is the responsibility of the Provider Relations Specialist to render customer support on behalf of the company they work for mainly to Physicians. Job tasks listed on the Provider Relations Specialist Resume are – serving as primary point of contact for providers, investigating and resolving provider claims issues, performing training and orientation for performance improvements, assisting in provider relations and service interactions, remediating claims, nurturing a positive relationship with providers, health plan and practice managers; assisting providers in setting up provider portal, verifying eligibility criteria and benefits, and performing all other duties as assigned.
Skills and abilities to be depicted on the resume should include – a good understanding of funding insurance and third-party administrating concepts, the ability to navigate and use PC applications, experience in medical codes and terminologies, prior insurance experience, and communication skills. To prepare for this job, it is necessary to earn a Master’s degree in the field of business administration or Healthcare administration.
Summary : A self-motivated individual who always pays attention to small detail seeking employment in which can utilize professional skills, expand with the company and embrace the vision of your establishment.
Skills : Excellent written and oral communication with great interpersonal skills.
Description :
Maintaining good working relationships with all contracted participating physician groups, physicians, hospitals, ancillary providers.
Responsible for day-to-day administration and operation of provider relations, network maintenance, performing in- services.
Assists in the development of policy and procedure and interpretation along with coordination of issue resolution.
Worked in conjunction with other departments that have field representatives.
Contracted providers through Joint Operations Meetings, open houses, special events, and office visits.
Liaison between the provider community and the health plan requiring travel Performed provider orientations for the rural counties.
Educate providers and members regarding verification of coverage, claim status, payment issues, and benefit policies.
Experience
10+ Years
Level
Senior
Education
MS
Provider Relations Specialist II Resume
Headline : Scheduling appointments and procedures. Managing incoming calls or incoming post services claims work. Handled Insurance claims for patient medications. Handles high volume of incoming calls from physician offices, Pharmacist, and patients.
Skills : Microsoft Word, Microsoft Outlook, Microsoft Excel.
Description :
Assisted vendors, and third party contractors tel-phonically with claim billing.
Reviewed billing patterns through the AS400 system for the prevention of fraud, waste, and abuse.
Aided contractual negotiations for pharmaceutical reimbursement.
Plan contacts and provider contacts for policy and procedures, orientation, ongoing training, issue resolution, compliance.
Responsible for establishing and maintaining strong relationships with providers and provider staff.
Provider and Office Manager Forums Recruited providers and resolved contractual problems Delivered provider contracts.
Collected encounter data Assisted providers in-person and via phone in resolving issues with Claims, Eligibility, Referrals.
Experience
5-7 Years
Level
Executive
Education
B.B.A
Lead Provider Relations Specialist Resume
Headline : Provider Relations Specialists work with hospitals, health systems, and other providers to coordinate services and care for patients to ensure that all of their needs are met.
Skills : Team Leader, Inventory Management, IT Trouble Shooting.
Description :
Providing IT support for those filling out an online application Level two calls.
Completing a data entry project that ended up as a new contract. Obtained medical provider contracts for Medicaid Insurance.
Serviced as Liaison between providers, health plans and corporate Answered queries and provided information to medical clinics.
Investigated and resolved HMO, PPO, Medicaid, and Medicare billing issues Reviewed and processed monthly eligibility reports.
Assisted doctors, hospitals and other health care providers with patient benefits and claims questions based on CPT and ICD-9 codes Utilized research tools.
Ensured great customer service by providing support and training to medical providers and staff on policies, procedures, and billing.
Processed medical provider network applications while ensuring an exceptional level of accuracy.
Headline : A self-motivated and goal-oriented professional with a strong customer service background that focused on building relationships and resolving issues.
Skills : Customer Service, Medical Billing, Data Entry, Billing.
Description :
Escalated claims issues by facilitating meetings with providers and coordinate research of claims issues internally.
Work closely with internal departments and providers to ensure services and required documentation is completed and submitted.
Effectively analyze, monitor, and manage productivity and caseloads, ensuring maximum productivity and billing potential Monitor.
Mediate issues and concerns presented by providers, or internal staff regarding providers including but not limited to the following program.
Hold individual meetings with providers to discuss work performance, caseloads, relocations, etc.
Perform new hire orientations for providers and conduct re-training as needed.
Enforce disciplinary action when applicable, including but not limited to implementing performance improvement plans.
Experience
5-7 Years
Level
Consultant
Education
Management
Provider Relations Specialist/Analyst Resume
Headline : A highly motivated well- rounded, professional, currently seeking an opportunity to transition into the field of Human Resources. A strong background in field based operations.
Skills : Experience with cisco system, MS-Excel.
Description :
Respond to initial client concerns and escalate where appropriate. Investigate, resolve and communicate provider claim issues and changes.
Ensure compliance guidelines by verifying medical provider's credentials, enrollment status and use current technology.
Educate and enforce policies/ procedures related to healthcare plan referrals and claims submission and problem solving among providers.
Perform provider orientations, including updating orientation materials to include most current/ relevant content.
Answer calls from providers as a primary contact via phone queue Receive mail regarding appeal requests and claims.
Research and resolve provider issues regarding complaints and claims reported having been processed incorrectly.
Responsible for reviewing and analyzing correspondence and account balances in order to collect payment for medical services rendered.
Experience
5-7 Years
Level
Executive
Education
Community Health
Provider Relations Specialist I Resume
Objective : To obtain a position as a customer service representative, where customer relations experience can be fully utilized to resolve customer's concerns and to improve customer satisfaction.
Skills : Appointment scheduling, customer service, medical terminology, payroll.
Description :
Coordinates and assists with finalizing and retrieving provider contracts with specific contractual, reimbursement and time requirements.
Distributes provider contract and credentialing information to providers, hospitals and ancillary facilities on a statewide basis.
Coordinates the tracking and completion of provider contracts and their set-up within Centene's systems.
Conducts provider education in accordance with the relevant requirements of each plan, as assigned, to include the development of provider manuals.
Develops and maintains participating provider database encompassing background information on providers.
Interfaces with network providers and proactively cultivates on-going relationships on a regular basis to maintain and improve provider satisfaction.
Participates in the scheduling and facilitation of providing educational seminars and conferences.
Experience
2-5 Years
Level
Junior
Education
BS
Provider Relations Specialist III Resume
Summary : Provider relations specialists are responsible for providing customer support on behalf of their companies, particularly to physicians. They work regularly with their employers clients, co-workers, supervisors.
Skills : Customer Service, Technical Skills.
Description :
Develop and offer services based on the collective expertise of Mayo Clinic physicians and researchers Perform third party administration.
Analyze, load, and maintain provider reimbursement contract arrangements.
Solving system-related problems; document and improve current processes.
Apply Medicare and Medicare coding edits to claims Run reports and analyze for payment discrepancies Implementation and renewals.
Providers regarding Medicare and Medicaid reimbursement and claim questions.
Implemented several new clients by writing reimbursement and claims processing specifications for the IT department.
Developed a procedure to show quality and verification standards for loading provider demographics into a claims system for external auditors.
Experience
10+ Years
Level
Senior
Education
Business Administration
Jr. Provider Relations Specialist Resume
Objective : Career opportunity with an agency that services the mental health population, using organizational, communication, and supportive skills to assist them with achieving their goals.
Skills : Communication Skills, Technical skills.
Description :
Communicated current Health Choice updates to physician practices on managed care topics that affect the network such as contracts.
Provided oversight and management on larger claims/administrative issues related to Health Choice's contracts.
Established and maintained relationships with network provider practices through the conduction of on-site educational and supportive services.
Managed communication to the director of provider services regarding urgent provider issues, unresolved customer service issues.
Developed and maintained the Health Choice Monitor on a monthly basis.
Educated providers on the new and upcoming SharePoint Web portal.
Accounted for the continuous promotion of Health Choice services to increase awareness and utilization of services.
Experience
2-5 Years
Level
Junior
Education
Masters
Asst. Provider Relations Specialist Resume
Objective : Outstanding healthcare & insurance professional with over 13 years of versatile experience working for service providers delivering marketing intelligence products and services.
Skills : MS-Office, Customer Service.
Description :
Managed physician network by developing and maintaining relationships to drive business results within a specific geographic area.
Served as a resource to Network Management Account Executives for contracting and provider set up questions/issues.
Provided service, education, and quality control to network physicians/providers/CMS/ Medicare Contractors.
Facilitated the agreement assignment process for new and existing provider groups.
Assisted the Contract Management Coordinator as necessary to assess issues/problems being encountered by providers and staff.
Generated reports to support credentialing, contract negotiating, and provider services activities.
Identified network gaps and completes contracts or works with Network Development.
Conducted site visits to service providers, resolve issues, educate staff/providers on policies.
Experience
2-5 Years
Level
Junior
Education
Healthcare Management
Provider Relations Specialist/Director Resume
Objective : Seeking a position in the Medical field that will allow to utilize skills and experience. They work regularly with their employers (to improve customer service) clients, co-workers, supervisors, and physicians.
Skills : MS-Excel, Computer Skills.
Description :
A professional position with the responsibility to develop and deliver annual provider seminars.
The managed territory of provider relationships for Ulster, Dutchess, and Sullivan counties.
Selected Contributions: Collaborate externally with physicians, facilities, and other providers in Ulster, Dutchess.
Recognized for developing a highly successful relationship with physician's offices by providing accurate, courteous, and timely support.
Proactively educated offices on changes in policy and procedures to ensure they did not encounter unnecessary rejections.
Developed and Delivered successful annual provider seminars throughout NYS while continuing to maintain current territory assignment for provider relations.
Partnered with internal departments for claim and call center operations to seek data for analysis of customer service.
Experience
2-5 Years
Level
Junior
Education
BS
Associate Provider Relations Specialist Resume
Headline : To obtain a position that will enable to utilize administrative and medical office skills to provide excellent patient/customer care.
Skills : Microsoft Office, Customer Service.
Description :
Coordinate and monitor semi-annual quality on-site reviews of all contracted providers and accountable for OIG checks semi-annually.
Ensures audit checklist is completed following the implementation of all contracts.
Interfaces with the organization's departments and maintains a provider database to communicate appropriate contract information.
Manages provider network as the contract liaison to address provider/Immanuel Pathways concerns in a timely and efficient manner.
Provides the initial provider orientation training to all contracted providers and provides updated annual training material as needed.
Provides, at a minimum, quarterly communications to all contracted vendors related to organizational updates, satisfaction survey results.
Communicates contracted vendor status changes and revisions to contracts to the leadership team.
Experience
5-7 Years
Level
Executive
Education
BA
Provider Relations Specialist Resume
Headline : Driven and skilled Medical Insurance Billing and Coding Specialist with a customer service background looking to lend skills to a medical team.
Skills : Customer Service, MS-Office.
Description :
Perform duties to act as a liaison between providers, the health plan and corporate including investigating and resolving provider claims issues.
Perform training, orientation and coaching for performance improvement within physician practices.
Serve as a primary contact for providers serving as a liaison between the provider and the health plan.
Conduct meetings with the providers documenting discussions, issues, attendees, and action items researching claims.
Initiate entry or change of provider related database information and oversee testing and completion of the change requests.
Investigate, resolve and communicate provider claim issues and changes.
Educate providers regarding policies and procedures related to referrals and claims submission, web site education.
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