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.
- 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.
- 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.
Provider Relations Representative Salaries
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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.
Years of Experience Distribution
Provider Relations Representative Insights
“I think we now have a great team and I look forward to working with them more.”
“Supervisors in this department were rude and I would never go back to that department.”
“I worked as a contractor and the pay was lower than all others in same position.”
“I feel the person who evaluated my client was racist cause she (my client) was black.”
“The CEO Anuj Sonpal is the most arrogant person I have ever met in my life.”
“You learn a ton if you’re a new grad; it’s a great way to gain experience.”
“There used to be 9 paid holidays a year and they just removed one for this calendar year.”
“I've enjoyed working with my team and it feels good to know our work helps people.”
Provider Relations Representative Interviews
Frequently asked questions about the role and responsibilities of a Provider Relations Representative
- Customer Care Manager
- Customer Success Manager
- Customer Service Manager
- Customer Relations