Provider Relations Representative

CLAREMEDICA HEALTH PARTNERS LLC•Hialeah, FL

1d•Onsite

About The Position

The Provider Relations Representative supports the specialty network of providers, ensuring access to quality healthcare services. He/She plays a pivotal role in fostering and maintaining strong and effective relationships with the network. The role ensures that providers are well-informed, compliant with policies, and contributing to the overall success and efficiency of the specialty network.

Requirements

Bachelor’s degree
2+ years of experience in provider relations
Must speak English & Spanish fluently
Strong communication and interpersonal skills, with the ability to build rapport with healthcare professionals
Strong organizational skills with attention to detail and ability to manage multiple priorities

Responsibilities

Support, develop and maintain service relationships with all participants (physicians, providers and administrators) of a provider network
Respond to electronic and direct inquiries from clients about policies, rates, changes, referrals, eligibility, credentialing, etc.
Assist with monitoring and proper filing of all provider contracts
Coordinate and tracks all provider audits and re-credentialing including running reports as needed
Ensure all provider documentation is complete and accurate, including provider data entered into the provider database and Insite
Maintain and update preferred provider network data/reports
Resolve administrative concerns affecting network providers under their contract guidelines
Communicate provider status with centers and departmental leads
Resolve any and all concerns presented by providers and advise them on new and existing policies and procedures
Coordinate EHR training upon on-boarding
Coordinate and communicate in-house specialist schedules