What does a Provider Relations Representative do?

Provider relations representatives are responsible for establishing, maintaining, and servicing relationships with the providers such as physicians, hospitals, and other medical facilities who participate in a healthcare provider network. This position involves direct daily interaction with providers and their staff. These representatives create and explain resources related to policies, processes, approval timelines, and other actions. They implement and oversee account management tools and systems to ensure accurate records and efficient service. They may also perform data analysis to identify and evaluate key metrics.

Provider relations representatives typically have a bachelor’s degree in a business or computer science field, although an equivalent combination of relevant professional experience may be acceptable. They must have excellent customer service and communication skills, and be highly organized. Proficiency with common office software programs is expected.

What responsibilities are common for Provider Relations Representative jobs?
  • Assist in resolving elevated and complex provider service complaints.
  • Assist in the development of the department strategies and goals.
  • Ensure the accurate implementation, and administration through matrix partners.
  • Create and manage initiatives that improve total medical cost and quality.
  • Organize and file all relevant reports, leases, and paperwork.
  • Conduct service follow-up when work is complete.
  • Develop and maintain key processes established by the business.
  • Participate and/or take the lead in most challenging internal or external projects.
  • Assess, plan and provide patient care under the supervision of a physician.
  • Manage key provider relationships and is accountable for critical interface with providers and business staff.
  • Manage strategic positioning for provider contract, develop networks and identify opportunities for greater value-orientation and risk arrangements.
  • Obtain and analyze financial performance quality metrics and reports to providers on the impact to performance.
  • Prepare reports/documents, assists with online reviews and post-survey follow-up activities.
  • Document and provide performance feedback in a timely manner.
  • Support and provide direction to develop network analytics required for the network solution.
  • Research problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues.
  • Track departmental effort, status and manage priorities of customers.
  • Conduct ongoing QA audits of the process to ensure accuracy of provider data entry by staff.
  • Maintain accurate tracking mechanisms and analysis, action plans for management insight
  • Perform community inspections to ensure aesthetics are maintained to company expectations.
What are the typical qualifications for Provider Relations Representative jobs?
  • Bachelor's or Graduate's Degree in business, business administration, finance or behavioral sciences or equivalent experience.
  • Prior consulting experience.
  • A natural problem solver and leader.
  • Is a professional at all times and is comfortable making decisions.
  • Can collaborate with teams and members to achieve goals.
  • A critical thinker with demonstrated work ethic.
  • Fluency in medical procedures such as intubation, suturing, wound closure, and patient intakes.
  • Understanding of HIPAA protocols and regulations.
Education--
Work/Life Balance
3.3 ★
Salary Range--
Career Opportunity
3.1 ★
Avg. Experience2-4 years

Provider Relations Representative Salaries

There are no current reports for Provider Relations Representative salaries. You can add additional job titles in your job preferences to see related salary information.

Glassdoor Estimated Salary

Provider Relations Representative Career Path

Learn how to become a Provider Relations Representative, what skills and education you need to succeed, and what level of pay to expect at each step on your career path.

Provider Relations Representative

Years of Experience Distribution

0 - 1
28%
2 - 4
67%
5 - 7
2%
8+
3%
Not including years spent in education and/or training

Provider Relations Representative Insights

Read what Provider Relations Representative professionals have to say about their job experiences and view top companies for this career.
MedUSAMedUSA
Provider Relations Representative
26 Apr 2022

“I think we now have a great team and I look forward to working with them more.”

UPMCUPMC
Provider Advocate
2 Nov 2022

“Supervisors in this department were rude and I would never go back to that department.”

Modern MedicalModern Medical
Provider
18 Apr 2022

“I worked as a contractor and the pay was lower than all others in same position.”

Fresno County In-Home Supportive Services Public AuthorityFresno County In-Home Supportive Services Public Authority
Ihss Provider
24 Nov 2022

“I feel the person who evaluated my client was racist cause she (my client) was black.”

Valorem AdvisorsValorem Advisors
Investor Relations Associate
12 Oct 2022

“The CEO Anuj Sonpal is the most arrogant person I have ever met in my life.”

Total Access Urgent CareTotal Access Urgent Care
Provider
29 Oct 2022

“You learn a ton if you’re a new grad; it’s a great way to gain experience.”

Foresight Mental HealthForesight Mental Health
Provider
11 Nov 2022

“There used to be 9 paid holidays a year and they just removed one for this calendar year.”

AledadeAledade
Provider Networks
4 Feb 2021

“I've enjoyed working with my team and it feels good to know our work helps people.”

See More

Provider Relations Representative Interviews

Frequently asked questions about the role and responsibilities of a Provider Relations Representative

The most similar professions to Provider Relations Representative are:
  • Customer Care Manager
  • Customer Success Manager
  • Customer Service Manager
  • Customer Relations

Related Careers

Customer Care Manager
$51,934
Customer Success Manager
$83,000
No skills overlap
Customer Service Manager
$72,000
Customer Relations
$49,000
No skills overlap

Provider Relations Representative jobs