Provider Relations Representative Job Description Template
The Provider Relations Representative is responsible for maintaining and improving relationships with provider organizations. This position will collaborate with providers to identify issues and potential solutions, proactively communicate updates and changes, and ensure timely resolution of concerns. The Provider Relations Representative will also develop strong working knowledge of the products and services offered by the company in order to provide accurate information to providers. This position requires excellent communication skills, both written and verbal, as well as strong interpersonal skills.
Provider Relations Representative Job Responsibilities
- Serve as a liaison between providers and the organization.
- Build and maintain positive relationships with providers.
- Educate providers on the organization's products and services.
- Resolve provider concerns in a timely and efficient manner.
- Monitor provider performance and make recommendations for improvement when necessary.
Objectives
- To establish and maintain positive working relationships with providers in order to facilitate the provision of quality health care services to members.
- To promote provider satisfaction through effective communication and negotiation of contracts, reimbursement rates, and other issues.
- To ensure that providers understand and comply with health plan policies and procedures related to claims processing, utilization management, provider credentialing, and other areas.
- To monitor provider performance metrics such as claim denial rates, length of stay, readmission rates, etc., and take action as necessary to improve results.
- To investigate provider complaints received from members or other sources, work with providers to resolve issues, and take disciplinary action when warranted.
Provider Relations Representative Job Skills & Qualifications Needed
- The skills and qualifications needed for the role of Provider Relations Representative are: excellent communication and interpersonal skills, strong organizational and time management skills, ability to work independently, computer proficiency, and experience with healthcare provider relations.