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Provider Relations Specialist

2 months ago

Miami, United States Premium Health Care Full time

Premium Healthcare is looking for a provider relations representative to liaise with healthcare providers and clients on healthcare-related issues, of which the majority are related to claims and provider participation.

To ensure success as a provider relations representative, you should be highly organized and have excellent communication skills. Ultimately, a top-notch representative should resolve queries and train healthcare providers to ensure operational efficiency.


Provider Relations Representative Responsibilities:

  • Initiating and maintaining effective channels of communication with service providers and clients.
  • Gathering, reviewing, and verifying all pertinent information relating to participating healthcare providers.
  • Establishing and maintaining relationships with assigned healthcare providers through office visits, telephone calls, prompt resolution of issues, and excellent customer service.
  • Conducting training of service providers on policies, procedures, service lines, and available technology.
  • Answering questions from doctors' offices on benefits.
  • Gathering, reviewing, and submitting relevant documentation needed for claims processing.
  • Managing healthcare provider accounts to achieve company strategies and goals.
  • Maintaining a working knowledge of all applicable federal, state, and local laws and regulations regarding healthcare.
  • Identifying shortfalls in healthcare provision and initiating improvement opportunities.


Provider Relations Representative Requirements:

  • Knowledge of EMR software, AdvanceMD and Eaglesoft.
  • A bachelor's degree in healthcare administration or equivalent.
  • A minimum of 2 years' experience in client services, provider relations, and claims processing.
  • Knowledge and understanding of claims processes and data capturing.
  • Proficiency in creating presentations, training documents, reports, and analytical graphs.
  • Proficiency in MS Outlook, Excel, and Word.
  • Ability to work independently.
  • Excellent verbal and written communication skills.
  • Good problem-solving skills.


Job Type: Full-time


Benefits:

  • Employee discount
  • Flexible schedule
  • Paid time off
  • Tuition reimbursement


Schedule:

  • 8 hour shift
  • Day shift
  • Holidays
  • Monday to Friday
  • No weekends


Experience:

  • Call center: 1 year (Preferred)
  • Customer service: 1 year (Required)