Provider Relations Representative

CLAREMEDICA HEALTH PARTNERS LLC • Miami, FL

8d

About The Position

At Claremedica, exceptional is the standard. Driven by our purpose to enhance the lives of the seniors in the communities where we have the privilege to work, live, and play, the Claremedica team is comprised of the brightest and best in their fields of expertise. From clinical excellence to unparalleled administrative support and beyond, we’re working together to help seniors live happier, healthier, fuller lives. That kind of teamwork and passion for excelling can only exist in a workplace that fosters employees’ growth and wellness and where their full potential and value are realized. At Claremedica, we’re excited about great people like you. We’re even more excited to support you with the resources, training, benefits, competitive compensation, and more to help you thrive and succeed in our communities. Opportunity awaits – welcome to Claremedica. ESSENTIAL FUNCTIONS 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, complaint 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees