Explore the critical requirements, core duties, primary responsibilities, and key skills that should be included in a comprehensive Provider Relations Representative job description.
What does a Provider Relations Representative do?
A provider relations representative works with healthcare providers on behalf of a healthcare agency. They build and maintain relationships with providers, and keep them informed about products, services, and technology available to them.
Job Description
We need a provider relations representative to work with healthcare providers and clients on issues related to healthcare, specifically claims and provider participation. You will also enter claims data for processing.
To be successful in this role, you should be organized and have good communication skills. Your main goal will be to resolve any issues and train providers to improve efficiency.
Job Duties and Responsibilities
- Communicating effectively with providers and clients.
- Gathering and verifying information about participating healthcare providers.
- Building and maintaining relationships with assigned providers through office visits, phone calls, and excellent customer service.
- Training providers on policies, procedures, services, and technology.
- Answering questions from doctors' offices about benefits.
- Gathering and submitting necessary documents for claims processing.
- Managing provider accounts to meet company goals.
- Keeping up-to-date with healthcare laws and regulations.
- Assisting with more complex benefit inquiries.
- Identifying areas for improvement in healthcare and suggesting solutions.
Requirements and Qualifications
- Bachelor's degree in healthcare administration or equivalent.
- At least 2 years of experience in client services, provider relations, or claims processing.
- Knowledge of claims processes and data entry.
- Proficiency in creating presentations, reports, and graphs.
- Proficiency in MS Outlook, Excel, and Word.
- Ability to work independently.
- Strong verbal and written communication skills.
- Good problem-solving abilities.
Alternate Job Titles
- Provider Network Relations Representative
Provider Relations Representative Salary
The earning potential of a Provider Relations Representative can vary significantly based on factors such as geographic location, industry, professional experience, educational background, and the specific employer. On average, the annual salary for an Provider Relations Representative in the United States is approximately $60668.
Discover Provider Relations Representative Openings - Build Your Career