Provider Relations Representative

TEKsystems•Lincoln, NE

5d•$20 - $20•Hybrid

About The Position

• Provide quality customer service through daily contact with providers ensuring they are educated on all contractual issues. • Strengthen provider loyalty and ensure required persistency of network is achieved. • Daily liaison for panel leasing arrangements including administration, customer complaint resolution, and claim discrepancy situations. • Extensive knowledge and proficiency of the Managed Care imaging system. • Responsible for the credentialing and re-credentialing of our network providers. • Responsible for the reporting of providers to the HealthCare Integrity and Protection Data Bank and related state licensing boards. • Assist in recruitment of providers in targeted areas and keep abreast of the current recruitment plan to provide accurate information to our customers. • Partner with our Provider Network Representatives to help expand our growing network. • Develop and maintain relationships with contacts from assigned files, and make the appropriate updates or changes to our system as needed. • Assist in the fee negotiation process between active or potential network providers and our Actuarial department, providing the appropriate information for fee review. • Provide effective complaint resolution for our insured members and network providers. This may involve educating dental offices regarding their agreement, and acting as a mediator between dental office and insured persons. • Meet all functional measurements when processing work from the Managed Care Imaging queues. • Partner with the Compliance and Law departments to ensure that we are following state laws involving PPO contracts and Credentialing requirements. • Other duties as assigned. #eastpriority25

Responsibilities

Provide quality customer service through daily contact with providers ensuring they are educated on all contractual issues.
Strengthen provider loyalty and ensure required persistency of network is achieved.
Daily liaison for panel leasing arrangements including administration, customer complaint resolution, and claim discrepancy situations.
Extensive knowledge and proficiency of the Managed Care imaging system.
Responsible for the credentialing and re-credentialing of our network providers.
Responsible for the reporting of providers to the HealthCare Integrity and Protection Data Bank and related state licensing boards.
Assist in recruitment of providers in targeted areas and keep abreast of the current recruitment plan to provide accurate information to our customers.
Partner with our Provider Network Representatives to help expand our growing network.
Develop and maintain relationships with contacts from assigned files, and make the appropriate updates or changes to our system as needed.
Assist in the fee negotiation process between active or potential network providers and our Actuarial department, providing the appropriate information for fee review.
Provide effective complaint resolution for our insured members and network providers. This may involve educating dental offices regarding their agreement, and acting as a mediator between dental office and insured persons.
Meet all functional measurements when processing work from the Managed Care Imaging queues.
Partner with the Compliance and Law departments to ensure that we are following state laws involving PPO contracts and Credentialing requirements.
Other duties as assigned.